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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018375
Report Date: 08/16/2024
Date Signed: 08/16/2024 04:07:29 PM

Document Has Been Signed on 08/16/2024 04:07 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:HOLCOMB FAMILY CHILD CAREFACILITY NUMBER:
198018375
ADMINISTRATOR/
DIRECTOR:		HOLCOMB, LEAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 531-6395
CITY:DUARTESTATE: CAZIP CODE:
91010
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 6DATE:
08/16/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Leah Holcomb, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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At 1:45 pm Licensing Program Analysts (LPAs) Saul Valenzuela and Lilli Babcock conducted an unannounced required inspection to the above facility. LPAs met with Leah Holcomb, Licensee who guided analysts on a tour of the facility. Per Licensee, there are 10 children that are currently enrolled. A children’s roster was available for review. There were 5 children present upon arrival- 1 being an infant.

The licensee states that 2 adults and no children currently live in the home. Per Licensee, they currently has two assistants. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home. Licensee states that there are no firearms stored in the home.

This is a two story home which consists of 3 bedrooms, 3 restrooms, living room, dining room, kitchen, garage, and front patio (fenced). The children have access to living room, dining room, and the restroom located on the first floor near the living room.

Per licensee, areas off limits to children and parents include entire: second floor, front patio, garage, and kitchen. The LPA toured all areas used by children during this visit. LPAs observed a baby gate at the bottom of the stairs making second floor inaccessible.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Saul Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2024
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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Document Has Been Signed on 08/16/2024 04:07 PM - It Cannot Be Edited


Created By: Saul Valenzuela On 08/16/2024 at 02:52 PM
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: HOLCOMB FAMILY CHILD CARE
FACILITY NUMBER: 198018375

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/16/2024

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
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Based on observation and record review, the licensee did not comply with the section cited above in one out of one infant does not have a sleep log on file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/16/2024
Plan of Correction
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Per licensee she will document and maintained the sleeping log and will send sleeping log to LPA via email.
Type B
Section Cited
CCR
102417(g)(7)
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.


This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on record review, the licensee did not comply with the section cited above in two out of five children do not have an emergency information card on file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/16/2024
Plan of Correction
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4
Per licensee she will have parents of child #4 and child #5 fill and sign required documents and send proof to LPA via email.
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:Brandi VanOosten
LICENSING EVALUATOR NAME:Saul Valenzuela
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2024


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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: HOLCOMB FAMILY CHILD CARE
FACILITY NUMBER: 198018375
VISIT DATE: 08/16/2024
NARRATIVE
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All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a landline that stays at the facility during operation hours. There is ventilation and heating (central). The following was observed and reviewed during this inspection.

Detergents, cleaning compounds, and medications were observed to be inaccessible to children. At 1:50 pm LPAs observed child #4 sleeping in an infant rocker. According to Licensee the child #4 is over the age of 2 and was asleep in the infant rocker for about 20 minutes. LPA advised licensee to remove child from the rocker once they fall asleep and be placed on a mat or cot. The restroom that children use was observed to be safe and sanitary.

LPAs observed a fireplace in the living room which was barricaded and inaccessible for children in care. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 03/14/23, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable. 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 8/6/24.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the living room.

The home is observed to be clean and orderly. Where children less than five years old are in care, stairs are fenced or barricaded. There are toys available for children. Appropriate sleeping arrangements in cots and play pens were observed.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Saul Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: HOLCOMB FAMILY CHILD CARE
FACILITY NUMBER: 198018375
VISIT DATE: 08/16/2024
NARRATIVE
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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-andresources/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.

LPAs 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. Currently, children are using the local park for outdoor play time. Per licensee children are supervised by licensee and her assistant when they go to the local park. There are no pets on the premises.

The licensee is observed to be operating within the license capacity limitations.

At 2:00 pm children’s records were reviewed, child #4 and child #5 are missing Identification and Emergency information (LIC 700), consent for emergency medical treatment (LIC 627), notification of parent’s rights (LIC 995A), and affidavit regarding liability insurance (LIC 282). LPAs observed that child #5 does not have sleeping log on file.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Saul Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: HOLCOMB FAMILY CHILD CARE
FACILITY NUMBER: 198018375
VISIT DATE: 08/16/2024
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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 11/2025. There are first aid supplies available.

LPA observed that the Licensee and assistant do have proof of immunization record and the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file.

LPA issued a copy of the LIC 857 Children’s Records Review and the LIC859 Staff Records Review to the licensee during this inspection.



Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

MyChildCarePlan.org – Centers and Family Child Care Homes Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Saul Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: HOLCOMB FAMILY CHILD CARE
FACILITY NUMBER: 198018375
VISIT DATE: 08/16/2024
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Megan’s Law - Family Child Care Homes During the exit interview, the LICENSEE Leah Holcomb, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process

Based on the LPA’s observations 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.



A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee, Leah Holcomb.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Saul Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
LIC809 (FAS) - (06/04)
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