198021054-8-17-2022-33-CC-BBAT-CH8PJJ-20220812112137

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021054
Report Date: 08/12/2022
Date Signed: 08/17/2022 12:08:49 PM

Document Has Been Signed on 08/17/2022 12:08 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	HIOKI FAMILY CHILD CARE		FACILITY NUMBER:	198021054
ADMINISTRATOR:	TODD HIOKI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 313-8377
CITY:	SAN GABRIEL	STATE: CA	ZIP CODE:	91775
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	08/12/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:28 AM
MET WITH:	Applicant, Todd Hioki		TIME COMPLETED:	11:30 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	-This an amended version of the report issued to the facility on 08/12/2022 to reflect changes to details pertaining to fireplace. Licensing Program Analyst (LPA) Bardo Baluyot conducted an announced Pre-Licensing inspection. LPA conducted a COVID risk self-assessment upon entry. Upon arrival, LPA met with Applicant Todd Hioki. Applicant's wife/Assistant Leah Hioki was also present during the inspection. The facility is a one story, 2 bedroom and 3 bathroom home. Per Applicant, the majority of the day care area will be held outdoors in the home's 3 separate outdoor areas. Applicant guided LPA on a tour of the facility both indoors and outdoors. The day care area inside the home consists of the living room, sun room/den, one bedroom and one bathroom which is equipped with a toddler size toilet and sink. There is a fireplace in the living room that is made inaccessible by a metal gate. Per Applicant, the gas has been shut off and is inoperable. The master bedroom and one bathroom and garage will be off limits. The home was inspected for safety, comfort, cleanliness, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. There is 1 pet in the home (1 dog). Per applicant, child care will be provided from 9:00am to 2:30pm, Monday through Friday. Per Applicant, the following areas will be used for day-care: Living room area, Dining room, Sun room/Den, 1 bedroom, 2 bathroom, patio and 3 separate backyards areas. Per Applicant, Off-limits areas include: Front yard, Master bedroom, 1 bathroom, kitchen and garage. The hallway leading to the doors to off-limit areas is equipped with a child safety gate and are inaccessible to children. The applicant has all appropriate forms posted. LPA confirmed with the applicant that all adults residing in the home have obtained criminal record and TB clearance. The facility has a working cell phone which remains in the home at all times. Licensee has taken the 8-hour First Aid/CPR training, his certificate is valid thru 06/2024. Proof of immunization against influenza, pertussis, and measles for the applicant was readily available during today's inspection. 1 of 4

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022

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: HIOKI FAMILY CHILD CARE	FACILITY NUMBER: 198021054
	VISIT DATE: 08/12/2022

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
26
27
28
29
30
31
32

Applicant has completed the Mandated Reporter Training. There are operational combination smoke/carbon monoxide detector maintained throughout the home. The valve on the required 2A10BC fire extinguisher indicates fully charged and purchased on 7/8/2022.

In the absence of the licensee, a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.

The home has electrical outlet covers throughout and maintains a First Aid and Emergency Kit. There are age appropriate materials and sleeping equipment was available for children to be enrolled in care. Per applicant, there are no firearms in the home. All outdoor/backyard play areas are fenced with self latching gates. The applicant states that there are no poisons accessible to children in the home. The applicant does understand that poison must be locked with a key or combination lock. LPA did not observe any bodies of water on the premises.

The following was discussed with the applicant:
· 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.

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. The family day care home shall maintain documentation of the required immunization or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.

· A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.

2 of 4

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022

LIC809 (FAS) - (06/04)

Page: 2 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: HIOKI FAMILY CHILD CARE	FACILITY NUMBER: 198021054
	VISIT DATE: 08/12/2022

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
26
27
28
29
30
31
32

· Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.

· The fire extinguisher type 2A10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked and batteries replaced as needed.

· Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

· Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

· Fire and safety drills must be performed every six months and documented for review by the Department.
· Smoking is prohibited in a family child care home.

· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

· Saucer chairs, bouncers, walkers, or any similar items are prohibited.

· All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

· Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

Applicant states that they will not care for infants.

Page 3 of 4

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022

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: HIOKI FAMILY CHILD CARE	FACILITY NUMBER: 198021054
	VISIT DATE: 08/12/2022

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
26
27
28
29
30
31
32

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

A large family child care license may be granted after final review of the application. Once licensed, the licensee is required to adhere to the terms and limitation as stated on the license. Exit interview was conducted with Applicant, Todd Hioki.

Page 4 of 4

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022

LIC809 (FAS) - (06/04)

Page: 4 of 4