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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191228234
Report Date: 02/23/2022
Date Signed: 02/23/2022 02:16:44 PM

Document Has Been Signed on 02/23/2022 02:16 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:DENNIS FAMILY CHILD CAREFACILITY NUMBER:
191228234
ADMINISTRATOR:DENNIS, TONIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 797-5175
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 8DATE:
02/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Toni Dennis - LicenseeTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced annual random inspection to the above facility. At 12:15pm, LPA met with licensee, Toni Dennis. Also present during this inspection, is Sabrina Miller, Licensee’s Assistant. The licensee states that she currently has 12 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 7am-5:30pm, Monday to Friday.

This is a two-story home which consists of 5 bedrooms, 3.5 bathrooms, living room, family room, kitchen, dining room, downstairs basement, and back yard. The children use the basement as a child care space, the restroom, and backyard. Per licensee, areas off limits to children and parents include: 5 bedrooms, 3.5 bathrooms, living room, family room, kitchen. The licensee provides food for children in care.

The licensee states that 3 adults and 0 children currently live in the home. Licensee states that she currently has one assistant. Residents were noted on the attached LIC811. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises.

PHYSICAL PLANT


At 12:20pm, LPA was lead on a tour of the facility by the licensee. Licensee guided LPA to the basement which they stated is the main child care space for indoors. During the time of inspection the children in care were napping. LPA observed napping equipment in the form of cots. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. LPA observed them in the high cabinet. There are first aid supplies available. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. REPORT CONTINUES PAGE 1 of 4
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DENNIS FAMILY CHILD CARE
FACILITY NUMBER: 191228234
VISIT DATE: 02/23/2022
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At 12:25pm, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 02/05/2020, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. LPA discussed with licensee the importance of making sure the fire extinguisher is serviced each year or replaced. Per licensee, due to COVID, she did not feel comfortable to have anyone come inspect the fire extinguisher or go and get it replaced. LPA provided an Advisory Note, addressing the technical violation. Smoke and carbon monoxide detectors were tested and are operable. The licensee states that there is a land line on the premises but due to telephone service provider issues, LPA obtained Licensee's cell number to keep on file. Where children are less than five years old are in care, stairs are fenced or barricaded. LPA observed a child safety gate at base of stairs in the basement, making the living room area of the house inaccessible to children. There is a child safety gate which keeps stairs inaccessible to children. The living room or separate part of basement is used as isolation room.

At 12:30pm, LPA observed the back yard area. The outdoor play area was observed to be fenced. At this time, children are using the back yard for outdoor play time. There is a fake grass area and a concrete area for children to play. There are age appropriate equipment and toys for children to use. The licensee is observed to be operating within the license capacity limitations.

FACILITY RECORDS:


The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 07/31/2020. Licensee other personnel do not have complete mandated reporter training proof. LPA explained to licensee the importance of keeping up with their Pediatric CPR/First Aid training and the completing Mandated Reporter Training for the health, safety, and personal rights of children in care. The licensee does have proof of immunization against influenza, tuberculosis, pertussis, and measles. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation. At 12:50pm, during review of Children's files, LPA observed that 7 of 8 children's files were missing a copy of their immunization records. LPA discussed with the Licensee the importance of ensuring children have proof of their immunizations for their age before beginning care.

The following was discussed:


-Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. REPORT CONTINUES Page 2 of 4
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
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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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DENNIS FAMILY CHILD CARE
FACILITY NUMBER: 191228234
VISIT DATE: 02/23/2022
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-There is 1 pet on the premises. There is a small dog
-Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility.
-Smoking is prohibited in a license family child care home.

Infant Care: Licensee states that they are currently caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices. PIN 20-24-CCP was provided and explained during the inspection.

Incidental Medical Services (IMS):


The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

During this inspection LPA discussed PIN 20-06 CCP, Social And Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education and reviewed Child Care Covid-19 Self Assessment

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/


REPORT CONTINUES PAGE 3 of 4
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
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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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DENNIS FAMILY CHILD CARE
FACILITY NUMBER: 191228234
VISIT DATE: 02/23/2022
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Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative.
Exit interview was conducted with Licensee Toni Dennis, at 2pm, and Plan of Corrections were reviewed and developed. A copy of the report, was provided.
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/23/2022 02:16 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 02/23/2022 at 01:49 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: DENNIS FAMILY CHILD CARE
FACILITY NUMBER: 191228234

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 out of 2 Staff, Staff #1 and #2, did not have Mandated Reporter Child Care Provider Training completed in their file, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/09/2022
Plan of Correction
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Per Licensee, all personnel will complete the Mandated Reporter Child Care Provider (AB1207) training and submit proof to LPA by POC date.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 out of 2 Staff, did not have current Pediatric CPR/First Aid Certificates on file, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/23/2022
Plan of Correction
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Per Licensee, they will make sure personnel completes in person Pediatric CPR/First Aid training and will submit proof to LPA by POC date.
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:Claudia Guangorena
LICENSING EVALUATOR NAME:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/23/2022 02:16 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 02/23/2022 at 01:49 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: DENNIS FAMILY CHILD CARE
FACILITY NUMBER: 191228234

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 7 out of 8 Children's Files did not have immunization records present, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/09/2022
Plan of Correction
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Per Licensee, they will have parents bring or send copies of their child's immunization records. Licensee will send copies to LPA by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Claudia Guangorena
LICENSING EVALUATOR NAME:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2022


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