Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370812434
Report Date: 10/29/2019
Date Signed: 10/29/2019 01:05:14 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: 1DATE:
10/29/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Sylvia TanabeTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Jo Ann Legaspi conducted an unannounced inspection with the Licensee. The home was toured and inspected to ensure a safe environment for the care and supervision of children. Present in the home was the Licensee and one (1) daycare child. The daycare schedule is varied based on the needs of the daycare families.

The daycare has four (4) bedrooms, two (2) bathrooms, and has one (1) story. The off limits are the bedrooms, second bathroom and the kitchen; these areas barricaded with child safety gates. The following rooms are used for care: living room and one (1) bathroom. Licensee has provided adequate space for the children to eat, sleep and play within the home. The Licensee has sufficient toys and available equipment. All equipment that is used should be used only as intended by the manufacturer. Outdoor activities are conducted in the fenced front yard. Shading is also provided in the front yard. The Licensee acknowledged continuous, visual supervision is to be given to children whenever engaged in outdoor activities. The Licensee provides transportation for children. The Licensee acknowledged that whenever children are inside the provider’s vehicle, they shall be properly and safely restrained. Furthermore, the provider acknowledged that while children are inside the Licensee’s vehicle, they shall never be left unattended by Licensee and staff. Lastly, the Licensee confirmed they will uphold their vehicle’s regular maintenance to ensure its running safety.

The fire extinguisher, carbon monoxide and smoke detectors satisfy requirements and are operational. The first aide kit was observed to be complete. The last safety drill was on 07/30/2019. Hazardous items were secured inaccessible to children. There are no bodies of water in the home. There are no weapons in the home, per the Licensee. A review of staff records indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. First Aide and CPR certifications expire in 12/2019. The child roster was observed.


SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
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
VISIT DATE: 10/29/2019
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The Licensee does not dispense specialized medication or specialized medical care to children. The 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 Community Care Licensing. 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 provider was reminded of the following: report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in the home have criminal background clearances to avoid civil penalties associated with this requirement; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care.

Based on today's visit, no deficiencies were observed.

LPA provided the Licensee with the Notice of Site Visit – LIC 9213, which is to be posted for thirty (30) days. An exit interview was conducted with the Licensee, who was provided a copy of their Licensee Rights (LIC 9058 1/16). Their signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
LIC809 (FAS) - (06/04)
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