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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016029
Report Date: 06/13/2023
Date Signed: 06/13/2023 02:40:28 PM

Document Has Been Signed on 06/13/2023 02:40 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:BAROMA FAMILY CHILD CAREFACILITY NUMBER:
198016029
ADMINISTRATOR:BAROMA, NONAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 726-8268
CITY:GLENDALESTATE: CAZIP CODE:
91206
CAPACITY: 14TOTAL ENROLLED CHILDREN: 18CENSUS: 12DATE:
06/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Nona Baroma, LicenseeTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced required 1- year inspection to the above facility on 06/13/23. LPA arrived at the facility at 11:50 AM and met with Nona Baroma, Licensee who guided analyst on a tour of the facility. A COVID 19 risk assessment was conducted prior to entering the facility. Also present during this inspection, were Juvicfilma Sundwall, Doris Villanueva, and Maalexsa Ramos, Licensee’s Assistants. Per licensee, facility hours are Monday to Friday from 8:00 a.m. to 6:00 p.m. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to licensee.

The is a two story home located on the first level. The home consists of 5 bedrooms, 3 bathrooms, kitchen, living room, dining room, covered patio, detached garage, front yard and backyard (fenced). Per licensee, children use the one bedroom adjacent to the backyard, one bathroom in the hallway, living room, dining room, outdoor covered patio and back yard (fenced). Per licensee areas off limits to children and parents include: kitchen, master bedroom on the first floor, bathroom in the master bedroom, entire second floor which consists of two bedrooms and one bathroom, detached garage, and front yard. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report. Per licensee, parents enter the home through the side gate which leads to the backyard. Per licensee currently children use outdoor patio and backyard as classroom and sleep outside if weather permits.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 12:10 p.m., Licensee took this LPA on a tour of the home. LPA was toured through the interior starting with the one daycare bedroom and observed two infants in the cribs. LPA observed a child safety gate was placed by the stairs in the daycare bedroom which leads to the second floor to make the second floor inaccessible to the children. Next LPA toured the one bathroom in the hallway and did not observe any hazards. Next LPA toured the living room and dining room and did not observe any hazards. There was a fireplace in the living room which has been blocked off to prevent access. LPA observed a child safety gate was installed to the kitchen to make the kitchen inaccessible to the children. LPA observed a child safety gate was installed in the hallway of bedrooms to make two off-limit bedrooms in the
REPORT CONTINUES ON NEXT PAGE 1 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2023
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: BAROMA FAMILY CHILD CARE
FACILITY NUMBER: 198016029
VISIT DATE: 06/13/2023
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first floor inaccessible to the children. LPA observed the required 2A 10BC fire extinguisher was anchored to the wall in the kitchen. It was serviced on 06/13/22 as read by LPA from the service tag. Licensee tested the carbon monoxide and smoke detectors in the daycare bedroom. It sounded off the alarms and heard by LPA to be functional. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. 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.

Next LPA toured the backyard fenced. LPA observed 9 children were playing outside in the covered patio and backyard (fenced). Currently, children are using the back yard as classroom, nap area and for outdoor play time. The outdoor classroom. play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The licensee states that supervision is always provided. Per licensee, she takes children for walk in the stroller, wagons, or holding a rope under supervision.

Per licensee, she does not provide food for children in care. Licensee was advised that food is brought from the children’s homes, all containers must be labeled with child’s name and properly stored or refrigerated. Per Licensee, at 12:50 p.m. there are no weapons, firearms, pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises. There is a dog on the premises which is inaccessible to the children.

The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. During this inspection 12 children were present in the home, 3 being infants with licensee and her 3 assistants. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, currently she has 3 assistants. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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 11/2023 Licensee, does not have current required mandated reporter training certificate on file. There are first aid supplies available on the premises in the kitchen. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children.
REPORT CONTINUES ON NEXT PAGE 2 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
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: BAROMA FAMILY CHILD CARE
FACILITY NUMBER: 198016029
VISIT DATE: 06/13/2023
NARRATIVE
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At 10:50 a.m., facility roster was reviewed and completed. Per licensee currently there are 18 children enrolled. LPA reviewed 5 children's records, including emergency information from 18 enrolled children, and all 5 reviewed files were completed.

The licensee and her three assistants did not have proof of immunization against influenza, pertussis, and measles. Staff #3 did not have TB test clearance on file. 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 documented was conducted on 05/02/23.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted at the wall by the entrance in the backyard.LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours. Per licensee she does not carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) on 5 reviewed files.

INFANT CARE: Licensee states that she provides care to infants and currently has three infants enrolled in her daycare. Licensee states that infants sleep in the one dayare bedroom where they are constantly supervised. Appropriate sleeping arrangements and cribs were observed. (one crib for each infant in care was observed). Cribs or play yard did not hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards were observed to be free of loose articles and objects. No objects were observed to be hanging above or attached to the side of the crib. LPA did/did not observe any infants swaddled while in care. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.
REPORT CONTINUES ON NEXT PAGE 3 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
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: BAROMA FAMILY CHILD CARE
FACILITY NUMBER: 198016029
VISIT DATE: 06/13/2023
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SAFE SLEEP: LPA discussed the safe sleep regulations with licensee, 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 also informed 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. Boppy recall: https://www.cpsc.gov/Recalls/2021/The-Boppy-Company-Recalls-Over-3-Million-Original-Newborn-Loungers-Boppy-Preferred-Newborn-Loungers-and-Pottery-Barn-Kids-Boppy-Newborn-Loungers-After-8-Infant-Deaths-Suffocation-Risk
Medication: Incidental Medical Services (IMS) policy was discussed. The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.
LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.
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) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experienced. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding inspection tools and methods, please visit the Program website at www.cdss.gov/inforesouces/community-care-liceinsing/inspection-process


Exit interview conducted and report was reviewed with the Licensee, Nona Baroma at 3:00 p.m..
REPORT END 4 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 06/13/2023 02:40 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 06/13/2023 at 01:06 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: BAROMA FAMILY CHILD CARE
FACILITY NUMBER: 198016029

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2023

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 staff file review, the licensee did not comply with the section cited above and licensee and her assistants did not have current mandated reporter training certificate on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/13/2023
Plan of Correction
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Per licensee, herself and her three assistants will complete required mandated reporter training and certificates will be submitted to LPA via email.
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 staff file review, the licensee did not comply with the section cited above and licensee and her three assistants did not have proof of immunization against Measles (MMR) Pertussis (TDAP) and Influenza on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/13/2023
Plan of Correction
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Per licensee, required immunization proof will be submitted to LPA via email for herself and her three assistants.
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:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/13/2023 02:40 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 06/13/2023 at 01:10 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: BAROMA FAMILY CHILD CARE
FACILITY NUMBER: 198016029

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102369(b)(9)
Application for Initial License
Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on staff files review, the licensee did not comply with the section cited above and staff#3 did not have TB Test clearance on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/13/2023
Plan of Correction
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Per licensee, staff#3 will complete TB Test by plan of correction due date and a copy will be submitted to LPA via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
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:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2023


LIC809 (FAS) - (06/04)
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