Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370812434
Report Date: 12/15/2017
Date Signed: 12/15/2017 04:04:43 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:TANABE, SYLVIA FAMILY DAY CAREFACILITY NUMBER:
370812434
ADMINISTRATOR:TANABE, SYLVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 697-6519
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY:12CENSUS: 5DATE:
12/15/2017
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Sylvia Tanabe, LicenseeTIME COMPLETED:
04:04 PM
NARRATIVE
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Licensing Program Analyst (LPA), Marie Hernandez conducted the 3 Year inspection. LPA met with the Licensee. The Licensee accompanied LPA on the tour of the facility. Present are five children, one of whom is an
infant. The Licensee's pediatric CPR/First Aid expires on 12/2019. Discussed the annual fees. There are no bodies of water and/or weapons in the home. The storage areas for poisons, detergents, cleaning compounds and medications are inaccessible to children during the visit. The fire extinguisher meets State Fire Marshal standards. The facility has a working carbon monoxide detector and smoke detector in the home as required by regulation. The home has adequate lighting and ventilation for safety and comfort of children. The Licensee shall be present in the home when children are in care to ensure that they are fully supervised at all times. Licensee will ensure that the children are never left in parked vehicles. When Licensee is temporarily absent from the home, the licensee shall arrange for a substitute cleared adult with a pediatric first aid/CPR certification to care for and supervise the children in licensee’s absence. During the visit today, all individuals subject to a criminal record review have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed facility. The Licensee has completed the training on preventive health practices.
SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2224
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: TANABE, SYLVIA FAMILY DAY CARE
FACILITY NUMBER: 370812434
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/27/2017
Section Cited
CCR
102417(A((1)
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Operation of a Family Child Care Home. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. The Licensee has not maintained the fire/disaster drills. This poses a potential health and safety risk to children.
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The Licensee stated she will conduct a fire/disaster drill with the children and will document the drill by 12/27/2017. The proof shall be submitted to the Licensing Office by 12/27/2017. The Appeal Rights were discussed and provided to the Licensee.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2224
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2017
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: TANABE, SYLVIA FAMILY DAY CARE
FACILITY NUMBER: 370812434
VISIT DATE: 12/15/2017
NARRATIVE
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Reviewed the information regarding Sudden Infant Death Syndrome (SIDS) and SUIDS and back to sleep. The handout "A Child Care Provider's Guide to Safe Sleep was discussed and provided. The Licensee is reminded of the following: Due to health & safety, Infants cannot sleep in highchairs, baby swings, beds, sofas and/or car seats. Infants must always sleep in appropriate accommodations that do not pose a safety risk. Baby bouncers, baby rockers, baby jumpers, baby walkers and baby saucers are prohibited in the day care. Reviewed the criminal record transfer requests, mandated reporting requirements (AB 1207, incident reporting, fire/disaster drills and logs, child roster, the crib standards, child passenger safety law, immunization's, child's records, and the forms/records to keep at the facility. Discussed the ratio and capacity. The Licensee is reminded that smoking is prohibited in the day care. The Licensee is reminded that upon moving and/or changing the phone number, the Licensee must contact the licensing agency immediately. The Licensee has not maintained the disaster/fire drills. The Licensee has maintained the child roster. The forms and regulations can be obtained online at website: http://ccld.ca.gov. All the required documents are posted. LPA verified the Licensees immunization records.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

The following deficiency has been cited today. An exit interview was conducted and a copy of the report, appeal rights and the Notice of Site Visit was provided to the Licensee. LPA observed the Licensee post the Notice of Site Visit in a prominent place. Licensee states it is understood that this notice must be posted for 30 days.

SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2224
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2017
LIC809 (FAS) - (06/04)
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