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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191511402
Report Date: 02/10/2025
Date Signed: 02/25/2025 01:22:46 PM

Document Has Been Signed on 02/25/2025 01:22 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GRAHAM FAMILY DAY CAREFACILITY NUMBER:
191511402
ADMINISTRATOR/
DIRECTOR:		GRAHAM, GAILFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 620-0737
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
02/10/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Licensee Gail GrahamTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On 2/10/25 at 11:00am, Licensing Program Analysts (LPA)s Stephanie Li and Kamile Martin Conducted an unannounced annual inspection to the above facility. A risk assessment was conducted upon entry. LPA’s met with Licensee Gail Graham who led LPA on a tour of the facility. There were 6 children and 3 adults present upon arrival. Per Licensee, there is currently 12 children enrolled. A current children’s roster was available for review.

This is a one-story home which consists of 5 bedrooms, 2-bathroom, kitchen, dining room, living room, backyard (fenced) and front yard. The children use the bathroom in the hallway, three bedrooms, play room/patio as noted in the facility sketch initially submitted. Per licensee, areas off limits to children and parents include: 2 bedrooms, living room, dining room, kitchen, 2 bedrooms, one bathroom and front yard. The LPA toured all areas used by children during this visit. Hours of operation are Monday-Friday 5:30am-7:00Pm. LPA‘s toured all areas used by children during this visit.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. Per Licensee, there are NO firearms in the home and no bodies of water was observed.

The following was observed and reviewed during this inspection. Cleaning compounds, and medications were observed to be inaccessible to children. Per licensee, there are no poisons kept in the home. The restroom that children use was observed to be safe and sanitary. There is telephone service via cellphone and a landline. The home is observed to be clean and orderly with central ac and heat. Licensee provides breakfast, lunch and afternoon snack. There are toys available for children. Licensee has mats for napping children. There are first aid supplies available.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7
Document Has Been Signed on 02/10/2025 12:44 PM - It Cannot Be Edited


Created By: Stephanie Li On 02/10/2025 at 11:59 AM
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: GRAHAM FAMILY DAY CARE
FACILITY NUMBER: 191511402

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2025

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 observation and record review, the licensee did not comply with the section cited above licensee and are missing mandated reporter training certificates, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/24/2025
Plan of Correction
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Per licensee, herself, co-licensee, and assistants will complete the child care training portion and email certificates to LPA email address by 2/24/25.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in one assistant was missing proof of mmr and tdap immunizations, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/10/2025
Plan of Correction
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Per licensee, her assistant will get all her shots records from CVS and she will send photo images of proof of MMR and TDAP immunizations to LPA S Li cell phone by 3/10/2025.
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:Christina Gabelman
LICENSING EVALUATOR NAME:Stephanie Li
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2025


LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 02/10/2025 12:44 PM - It Cannot Be Edited


Created By: Stephanie Li On 02/10/2025 at 11:59 AM
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: GRAHAM FAMILY DAY CARE
FACILITY NUMBER: 191511402

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2025

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 observation and record review, the licensee did not comply with the section cited above in one child was missing proof of immunizations in file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/17/2025
Plan of Correction
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Per licensee, she has contacted parent during visit to request immunizations. Per parent, she will gather the shot records and bring a copy to licensee. Licensee will send a photo image of immunization records to LPA S Li phone by 2/17/25.
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:Christina Gabelman
LICENSING EVALUATOR NAME:Stephanie Li
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2025


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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRAHAM FAMILY DAY CARE
FACILITY NUMBER: 191511402
VISIT DATE: 02/10/2025
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LPA ‘s observed the following required posted documentation in the main entry way of the facility: Facility License, (LIC) 9148- Earthquake Preparedness form, Publication (PUB) 394- Notification of Parent Rights, Licensing Form LIC 9040- Facility Roster. LPA's observed licensee is missing the earthquake preparedness checklist or Car Seat PUB. LPA’s provided a copy of the forms and to licensee.

At 11:00am, LPA observed a fire extinguisher, it was last serviced on 9/20/2023. LPA’s advised licensee that fire extinguisher needs to be serviced every year or purchased every year and retain the receipt. Smoke and carbon monoxide detectors were tested and are operable. LPA’s observed a fireplace in the off limits area with a screen but it was not secured. A technical violation is being issued. See page lic9102. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill was conducted in 01/09/25. Smoking is prohibited in a licensed Family Childcare Home. Per Licensee, no one smokes in the home.



Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPA‘s observed the outdoor yard to have appropriate toys and other materials for children to use. LPA‘s did not observe any objects that can pose a danger to children in the outdoor yard. The licensee is observed to be operating within the license capacity limitations.

At 11:30 am, children and adults records were reviewed, including emergency information. Per licensee, she has 2 personnel employed. LPA’s observed one assistant during visit. Licensee and assistant is missing the Mandated Reporter AB 1207 Training Certificate assistant and co-licensee is missing the training as well. 1 adult and 1 child missing proof of immunization records. Deficiencies are being issued per Title 22 regulations. See deficiency page LIC809 D. Licensee ‘s CPR is current and expires 10/2025.


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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRAHAM FAMILY DAY CARE
FACILITY NUMBER: 191511402
VISIT DATE: 02/10/2025
NARRATIVE
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Licensee stated IMS is not being provided at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

LPA ‘s discussed the safe sleep regulations and discussed the Child Care Licensing Safe Sleep webpage at http://www.cdss.ca.gov/inforescources/child-care-licensing/public-information-and-resoucrces/safe-sleep as an additional resource. LPA’s also informed applicant/licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at http://www/cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Safe sleep log was reviewed by LPA Stephanie Li required infant forms were up to date in child’s file.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Megan’s Law - Family Child Care Homes During the exit interview, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov



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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRAHAM FAMILY DAY CARE
FACILITY NUMBER: 191511402
VISIT DATE: 02/10/2025
NARRATIVE
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MyChildCarePlan.org – Centers and Family Child Care Homes Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California

Based on Licensing staff observations and records review, the following deficiencies listed on the attached LIC 809D (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 and safety. A technical violation is being issued, see page LIC9102.


A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted, report was reviewed and appeal rights provided to Licensee Gail Graham



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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025
LIC809 (FAS) - (06/04)
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