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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500620
Report Date: 08/20/2021
Date Signed: 08/20/2021 03:52:34 PM

Document Has Been Signed on 08/20/2021 03:52 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:SHERMAN FAMILY DAY CAREFACILITY NUMBER:
191500620
ADMINISTRATOR:DORIS SHERMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 919-3349
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
08/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Doris Sherman, LicenseeTIME COMPLETED:
04:00 PM
NARRATIVE
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On 8/20/2021 at 1:30PM, Licensing Program Analyst (LPA) Thelma Razo held a Required - 1 Year inspection and met with Licensee Doris Sherman and Assistant Griselda Ramirez. LPA stated the purpose of the visit and together with Licensee, toured the facility to include the day care area: living room, bathroom by the living area, kitchen, dining room, family room, and backyard. The rest of this tri-level home is off limit. Stairs leading to the off limit areas were barricaded. There were 7 children in care (no infant) with two staff. Per Licensee, there is one adult family member living in the home with no minor.

The home was inspected for safety, comfort, cleanliness, telephone service (land line available), heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

Per licensee, there are no weapons, firearms or bodies of water on the premises. There were safe toys, play equipment and materials observed for children. Day care is required to have 2A 10BC fire extinguisher but the home has 3A-40BC which was bought on March 30/2021 (Home Depot receipt was viewed). Smoke and carbon monoxide detectors were tested and were in operable condition. Licensee and assistant have current Pediatric First Aid and CPR which expires on 1/2023 and 5/2023 respectively. Mandated Reporter Training was taken on 3/31/2020 by Licensee and assistant.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section. 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

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2021
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SHERMAN FAMILY DAY CARE
FACILITY NUMBER: 191500620
VISIT DATE: 08/20/2021
NARRATIVE
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SB792 (Immunization Requirements for Staff and Employees) was discussed with the Licensee. The Licensee and staff have required immunization documentation on file.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home.
CHILDREN’S FORMS/RECORDS, FACILITY FORMS/RECORDS and INFORMATION TO BE POSTED, Disaster drills, posting requirements, children records requirements, mandated child abuse and injury/ death reporting, criminal record transfer requirements, criminal record and child abuse clearances were also discussed during this visit.

LPA discussed and provided a copy of PIN 20-24-CCP Recently Approved Safe Sleep Regulations in Effect and LIC 9227 Individual Infant Sleeping Plan. Licensee provided a copy of Child Care Facility Roster to LPA.

Deficiencies were cited during this inspection. Refer to LIC 809-D.

The Notice of Site Visit (LIC 9213) was posted by LPA – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

An exit interview was held with Licensee, copy of this report provided together with Appeal Rights.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/20/2021 03:52 PM - It Cannot Be Edited


Created By: Thelma Razo On 08/20/2021 at 02:38 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: SHERMAN FAMILY DAY CARE
FACILITY NUMBER: 191500620

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/25/2021
Section Cited
CCR
102417(g)(1)

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Operation of a Family Child Care Home. Fire extinguishers and smoke detectors shall meet State Fire Marshall standards. This requirement was not met as evidenced by not having the required fire extinguisher 2A 10BC. This poses a potential health and safety risk to the children in care.
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Licensee is to submit proof that it is serviced on or before POC date of 8/25/2021.
Type B
08/25/2021
Section Cited
CCR
102417(g)(7)

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Operation of a Family Child Care Home. Parent's authorization for the licensee or registrant to consent to emergency medical care should be maintained on each child's file. This requirement was not met as evidenced by absence of consent for medical care in Child #1's file. This poses a potential health and safety risk to the children in care.
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Licensee is to submit a consent to emergency medical care for C1 by 8/25/2021.
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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:Brandi VanOosten
LICENSING EVALUATOR NAME:Thelma Razo
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2021


LIC809 (FAS) - (06/04)
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