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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016457
Report Date: 07/15/2021
Date Signed: 07/15/2021 03:08:10 PM

Document Has Been Signed on 07/15/2021 03:08 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:TOMA FAMILY CHILD CAREFACILITY NUMBER:
198016457
ADMINISTRATOR:TOMA, ZOILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 756-0991
CITY:SIGNAL HILLSTATE: CAZIP CODE:
90755
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
07/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Zoila Toma & Jennifer Cortez (Assistant)TIME COMPLETED:
03:28 PM
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Licensing Program Analyst (LPA) Raul Navarro conducted an unannounced random annual inspection on 7/15/2021. LPA arrived at 1:20 PM and met with Assistant Jennifer Cortez who guided this LPA on a tour of the facility. Also present was Licensee's Assistant. Licensee arrived at 2:05 PM. There were four children present during today’s inspection. Licensee states that there are currently 20 children enrolled. The Licensee is within the conditions, limitations, and capacity specified on the license. The children's roster was reviewed and is current.

This is a one story home which consists of three bedrooms and two bathrooms. Areas used by the children include the living room, dining room, two bathrooms, one bedroom/activity room (converted garage), and backyard. Per Licensee, areas off limits to children and parents include: two bedrooms, kitchen, and front yard. Outdoor play area is fenced. Licensee and or assistants maintains visual supervision at all times while children are outside. The Licensee uses the outdoor play area as the designated ill isolation area.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. There is a working telephone service maintained in the home. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed childcare home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are locked as required.

Per Licensee, there are no weapons or firearms in the home. LPA did not observe any bodies of water on the premises. There are safe toys, play equipment and materials observed for children. Emergency Disaster Plan was posted at the time of inspection. The valve on the required 2A 10BC fire extinguisher indicates fully charged, last purchased on 06/2021. Smoke and carbon monoxide detectors were tested and are in operable condition.
Report continues- Page 1 of 3
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2021
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 3
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: TOMA FAMILY CHILD CARE
FACILITY NUMBER: 198016457
VISIT DATE: 07/15/2021
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The Licensee has current Pediatric First Aid and CPR, which will expire on 08/2022. Proof of immunization against influenza, pertussis, and measles for the Licensee and Assistants was readily available during today’s inspection. The Licensee and Assistants have also taken the Mandated Reporter Training.

Licensee states that she is currently caring for four infants. The infants sleep in the dining room where they are constantly supervised. Appropriate sleeping arrangements was observed. Play yards did not hinder the entrance or exit from the sleeping space. Play yards were observed to be free of loose articles and objects. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants are checked on every 15 minutes and the time of each 15 minute check is documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan was observed in the children's files.

The following was discussed: Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty. The Licensee shall be present in the home and shall ensure that children in care are supervised at all times.

Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. Infant walkers, johnny jumpers, saucer chairs, trampolines and any other item that falls into that category are not permitted in the facility. Car seats shall only be used for transportation purposes and shall not be used for sleeping. 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.

Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: TOMA FAMILY CHILD CARE
FACILITY NUMBER: 198016457
VISIT DATE: 07/15/2021
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The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed.

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

Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file. LPA issued the Confidential Names List (LIC 811) to the licensee during this visit. The Confidential Names List documents the children’s files that were reviewed during this inspection.

At this time, the Licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

Exit interview was conducted with Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.



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

Report ends- Page 3 of 3
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
LIC809 (FAS) - (06/04)
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