198018367-1-30-2024-33-CC-JHUA-CZYQ4N-20240130105038

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198018367
Report Date: 01/30/2024
Date Signed: 01/30/2024 10:50:46 AM

Document Has Been Signed on 01/30/2024 10:50 AM - 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:	MIDDLETON FAMILY CHILD CARE		FACILITY NUMBER:	198018367
ADMINISTRATOR:	MIDDLETON, DIANNE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 671-7003
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 8	CENSUS: 1	DATE:	01/30/2024
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	08:56 AM
MET WITH:	Dianne Middleton		TIME COMPLETED:	10:55 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Jennifer Hua arrived to facility at around 8:56am. LPA rang door bell and licensee answered through the Ring door bell and asked LPA to call her. LPA called licensee, and stated she is on her way to the doctor but will return to the facility. Licensee arrived at around 9:11am with a 3 year old child. Per licensee, parent is aware that child leaves the premise with licensee. LPA conducted an unannounced Required - 1 Year on-site inspection. A COVID-19 risk assessment was conducted. LPA stated the purpose of the visit and provided LIC 126 Entrance Checklist to facilitate the inspection. LPA was guided to a tour by Licensee. This is a single-story home with living room, 4 bedrooms, 2 bathrooms, kitchen, dining area. There are 1 adult and 3 minors residing in the home. There is 1 day care child in care during the inspection. The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations. Operation Hours are 7 days/week 23 hours/day. All areas identified on the Facility Sketch were inspected to include the following: · Childcare areas: Living room, dining area, kitchen, hall bathroom, There is no back or front yard. Licensee stated kids can play outside in front of the facility or the nearby apartment playground, licensee is physically outside with the children. · Off limit areas: All bedrooms, bathroom in master bedroom All areas used by children were inspected for safety, comfort, cleanliness, telephone, ventilation and heating (central). The licensees stated that there are no poisons in the home. The licensees understand that any poisons must be locked with a key or combination lock. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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: MIDDLETON FAMILY CHILD CARE	FACILITY NUMBER: 198018367
	VISIT DATE: 01/30/2024

NARRATIVE

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The valve on the required 2A 10BC fire extinguisher indicates it was fully charged and serviced on 6/27/22 as observed on service tag. Per licensee, will get it service by this week. Smoke and carbon monoxide combination detector in day care hallway were tested and were operable. Drills were conducted on 12/28/23. Per licensee, there are no bodies of water and no firearms and ammunition on the premises. Per Licensee, there is 1 small and 1 medium dog. There were toys observed for children. Posting requirements were observed to be posted at the time of inspection.

Children records were reviewed and observed to be complete. Roster reviewed.
LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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 https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Per licensee, currently no infants enrolled.

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 Per licensee, no child on any medication ore requiring IMS at this time.

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.

All adults present have obtained a criminal record clearance. The licensee she has current Pediatric First Aid/CPR certificate (expires on 8/6/2024) from the American Red Cross. Licensee has completed mandated reporter training on 10/13/22.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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: MIDDLETON FAMILY CHILD CARE	FACILITY NUMBER: 198018367
	VISIT DATE: 01/30/2024

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No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category are not permitted in a family child care facility.

INFANT CARE: The infant will sleep in the day care where they are constantly supervised. Appropriate sleeping arrangements and cribs will be available/observed. (one crib for each infant in care is required). Cribs or play yard will 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 shall be free of loose articles and objects. No objects shall be hanging above or attached to the side of the crib. LPA 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 document the time of each 15-minute LIC 9227 Plan shall be completed for each infant up to 12 months of age. 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. Per licensee, currently no infants enrolled.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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 experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/tion-process.

Deficiency cited on attached 809D. A notice of site visit was given and must remain posted for 30 days in an area accessible for review. Failure to post shall result in $100 civil penalty. Exit interview conducted with licensee, copy of report given. Licensee was provided copy of the Appeal Rights..

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/30/2024 10:50 AM - It Cannot Be Edited

Created By: Jennifer Hua On 01/30/2024 at 10:26 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: MIDDLETON FAMILY CHILD CARE	FACILITY NUMBER: 198018367
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in fire extinguisher has not been service annually as required, it is fully charged but was service on 6/27/2022 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2024
	Plan of Correction
1 2 3 4	Per licensee, will get it serviced and submit proof to LPA by POC due

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 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:

Ana Chico

LICENSING EVALUATOR NAME:

Jennifer Hua

LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC809 (FAS) - (06/04)

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