198400020-7-7-2023-54-CC-AESA-CTHQA9-20230707115933

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400020
Report Date: 07/07/2023
Date Signed: 07/07/2023 11:59:45 AM

Document Has Been Signed on 07/07/2023 11:59 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	HOLLIMAN FAMILY CHILD CARE		FACILITY NUMBER:	198400020
ADMINISTRATOR:	PAULA A. HOLLIMAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 897-5222
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 4	DATE:	07/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Licensee Paula Holliman		TIME COMPLETED:	12:10 PM

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) Austin Estrada conducted an unannounced required 1-year inspection at the above facility. LPA met with the Licensee Paula Holliman and informed her of the purpose for the visit. LPA provided the inspection Entrance Checklist (LIC 126). Licensee guided LPA on a tour of the facility. There were 4 children, and 1 additional staff present during the inspection. All adults present during the inspection have obtained a criminal record clearance or exemption. Individuals residing in the home have been discussed and noted. Licensee provides care to children ages 1 year to 9 years old and operation days/ hours are Monday through Friday 6:00AM to 6:00PM. This is a two story home which consists of 3 bedrooms, 3 bathrooms, living room, kitchen, dining room (converted into daycare room), den (converted into daycare room), garage, and backyard (fenced). Childcare is provided in the living room, dining room (converted into daycare room), den (converted into daycare room), and backyard. Both the day care rooms are located near the kitchen area. The kitchen is accessible through passing to and from the day care rooms. Children use the restroom adjacent to the main entrance. The restroom children use was observed to be safe and sanitary. Areas off limits to children in care include the garage, 3 bedrooms and two bathrooms which are located on the second floor of the home. LPA observed a child safety gate making the stairs inaccessible to children in care. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation, and heating (central). LPA observed two air and heat units installed in the converted day care rooms. LPA observed 2 small dogs. Per Licensee, the dogs do not interact with children while in care. LPA observed the dogs to be located in the off limits garage. LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. All documents were observed to be posted at the entrance of the home. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610A- Emergency Disaster Plan and eviewed Safe sleep regulations with Licensee, including LIC 9227 (Infant Sleep Plan) for infants under 12 months and 15-minute sleep check documentation for infants 0-24 months. LPA discussed the Child Care

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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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Document Has Been Signed on 07/07/2023 11:59 AM - It Cannot Be Edited

Created By: Austin Estrada On 07/07/2023 at 11:22 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HOLLIMAN FAMILY CHILD CARE	FACILITY NUMBER: 198400020
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)(c)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above: LPA did not observe infant sleep logs for C1 and C2 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/14/2023
	Plan of Correction
1 2 3 4	Licensee will provide proof of infant sleep log for C1 and C2 to LPA via email by POC due date.

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:

Valarie Cook

LICENSING EVALUATOR NAME:

Austin Estrada

LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HOLLIMAN FAMILY CHILD CARE	FACILITY NUMBER: 198400020
	VISIT DATE: 07/07/2023

NARRATIVE

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There is an operable carbon monoxide detector and a smoke detector in the home. A fully charged Fire extinguisher (2A10BC) with a purchase receipt date of 5/6/23. The home maintains telephone service (mobile). LPA observed cleaning compounds and sharp objects such as knives located in the kitchen area inaccessible to children in care. Per Licensee, no children require medication.
Per Licensee there are no poisons stored in the home. LPA advised Licensee that all poisons must be locked away, not only inaccessible. Isolation area for sick children waiting to be picked up is in the living room, away from the other children. Per Licensee there are no firearms or weapons stored in the home.
Per Licensee, children bring their own food from home. LPA observed the food to be labeled with the child’s name and properly stored or refrigerated.
The home is observed to be clean and orderly. There are toys and other age-appropriate materials available for children. LPA observed sleeping mats in the daycare room. Per Licensee, children bring their own blankets which are taken home weekly to be washed. LPA observed a fireplace in the living room made inaccessible to children in care.
The outdoor play area was observed to be fenced and contain toys and other age- appropriate materials available for children. Per Licensee, children are supervised while playing outside. LPA did not observe any pools, spas, or other bodies of water. During the inspection, children present was observed to be treated with dignity and respect, observed to be receiving safe, healthful, and comfortable accommodations, furnishings, and equipment, and free from corporal and/or unusual punishment.
Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). LPA did not observe infant sleep logs for child 1 (C1) and child 2 (C2). LPA provided guidance on safe sleep regulations.
Personnel records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, and LIC 9108- Statement of Child and Mandated Reporter Training Certificate. Licensee’s CPR/First Aid expires on 6/25/24. LPA did not observe a current mandated reporter for the Licensee. LPA advised Licensee that mandated reporter training should be completed every two years.
Infant Care: Currently Licensee cares for 3 infants. Per Licensee the infants sleep on the napping mats. LPA

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HOLLIMAN FAMILY CHILD CARE	FACILITY NUMBER: 198400020
	VISIT DATE: 07/07/2023

NARRATIVE

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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 provided a copy of PIN 20-24-CCP: Recently Approved Safe Sleep Regulations in Effect.
Overnight Care: Per Licensee, overnight care is not provided.
Incidental Medical Services (IMS): 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm
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.
LPA advised Licensee that all adults age 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.
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 [email protected]. 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/process.
Based on the LPA’s observations, interviews and records review, the following deficiencies listed on the attached LIC 809D (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. Deficiencies include one type B violation.
An exit interview was conducted, and report was reviewed with Licensee. A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty. Appeal rights were discussed and provided to the Licensee.
Verification of Disaster and Fire Drills. The last drill was conducted on 3/24/23. All documents were observed during the inspection.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC809 (FAS) - (06/04)

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