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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020274
Report Date: 06/13/2023
Date Signed: 06/13/2023 11:05:02 AM

Document Has Been Signed on 06/13/2023 11:05 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:APPLEGATE FAMILY CHILD CAREFACILITY NUMBER:
198020274
ADMINISTRATOR:REBECCA APPLEGATEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 254-6957
CITY:GLENDALESTATE: CAZIP CODE:
91208
CAPACITY: 14TOTAL ENROLLED CHILDREN: 15CENSUS: 11DATE:
06/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Rebecca Applegate, LicenseeTIME COMPLETED:
11:10 AM
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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 8:30 AM and met with Alexander Applegate, Licensee's husband. Upon LPA's arrival licensee was not present in the home. Shortly after at 8:40 AM Licensee, Rebecca Applegate arrived 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, was Edita Isajanyan, Licensee’s Assistant. Per licensee, facility hours are Monday to Friday from 7:00 a.m. to 5:30 p.m. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to licensee.

This is a one story home located on the first level. The home consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room (FIREPLACE: inaccessible), family room, front yard, garage and backyard (fenced). Per licensee at 9:00 AM the children use the living room, dining room, family room, two bathrooms, one bedroom, kitchen, front yard, and backyard (fenced). Per licensee areas off limits to children and parents include: 2 bedrooms, garage, and concrete area in the backyard near outdoor grill area. LPA did not observe any stairs in the home. 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 main entrance which leads to the living room.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 9:00 a.m., Licensee took this LPA on a tour of the home. LPA was toured through the interior starting with the living room and dining room (daycare classrooms), LPA observed children's table, chairs, and toys, and a changing table in the living room and dining room. There is a fireplace in the living room which has been blocked off to prevent access. LPA observed all electrical outlets were covered in living room and dining room. Next LPA toured the kitchen and observed child proof safety latches on the cabinets where licensee stores sharp items and cleaning compounds. Next LPA toured the family room and observed sofas in the family room. Next LPA toured the one daycare bedroom and observed a bunk bed and toys in the bedroom. Next LPA toured the two daycare bathrooms and observed child proof
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)
Page: 1 of 4
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: APPLEGATE FAMILY CHILD CARE
FACILITY NUMBER: 198020274
VISIT DATE: 06/13/2023
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safety latches on the cabinets under the sinks. LPA observed the required 2A 10BC fire extinguisher was anchored to the wall in the garage. It was serviced on 09/01/22 as read by LPA from the service tag. Licensee tested the carbon monoxide and smoke detectors in the kitchen. 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. Currently, children are using the back yard for outdoor play time. The outdoor 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. LPA observed off-limit concrete outdoor grill area in the backyard was gated and inaccessible to the children. Next LPA toured the front yard (fenced) and did not observe any hazards. The licensee states that supervision is always provided.

Per licensee, children bring food from home or they sign up on food program. Licensee was advised that if 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 9:45 a.m there are no pets, weapons, firearms, pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises.

The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. During this inspection there were 11 children present in the home, 2 being infants with licensee and her two assistants. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, currently she has two 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 05/2025. Licensee, Rebecca Applegate completed required mandated reporter training on 05/29/2023. 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: APPLEGATE FAMILY CHILD CARE
FACILITY NUMBER: 198020274
VISIT DATE: 06/13/2023
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At 10:00 a.m., facility roster was reviewed and completed. Per licensee currently there are 15 children enrolled. LPA reviewed 5 children's records, including emergency information from 15 enrolled children, and all 5 reviewed files were completed. The licensee and her two assistants have have proof of immunization against influenza, pertussis, and measles.

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 05/22/23. Emergency Disaster Plan, Parent’s Rights Poster were observed to be posted at the wall by the entrance and the Facility License was posted inside the home in the living room.

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 carries liability insurance in accordance with standard established by Family Child Care statue.

INFANT CARE: Licensee states that she provides care to infants and currently there are three infants enrolled in her daycare. Infants sleep in the living room and dining room where they are constantly supervised. Appropriate sleeping arrangements and cribs were observed. (one crib for each infant in care was observed). 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 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)
Page: 3 of 4
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: APPLEGATE FAMILY CHILD CARE
FACILITY NUMBER: 198020274
VISIT DATE: 06/13/2023
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Medication: The licensee states that she is providing IMS at this time (see LIC857 for child information).
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Section 102417. 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. Licensee will submit plan of operation for Incidental Medical Services by 07/13/23.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.



At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today from the areas that were inspected today.

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, Rebecca Applegate at 11:10 a.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)
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