334803660-10-25-2022-09-CC-AROS-CKTSX5-20221103141521

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 334803660
Report Date: 10/25/2022
Date Signed: 10/25/2022 01:23:50 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/04/2022 and conducted by Evaluator Karrene Turner

COMPLAINT CONTROL NUMBER: 09-CC-20220804113101

FACILITY NAME:	HORN FAMILY CHILD CARE		FACILITY NUMBER:	334803660
ADMINISTRATOR:	JESSICA HORN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 315-6381
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92503
CAPACITY:	14	CENSUS: 9	DATE:	10/25/2022
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Jessica Horn, Licensee		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Documentation - Licensee allowed staff to work without immunization records on file

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Kay Turner arrived at the facility to provide investigation findings of the reported above allegation. LPA Turner met with the licensee, Jessica Horn, at the time of the inspection and stated the purpose of today’s inspection. LPA Turner toured the facility and took census. During the initial inspection on August 4, 2022, LPA Phillips interviewed pertinent parties and obtained relevant documents related to the investigation.

The allegation states that the licensee allowed staff to work at the family child care home without immunizations on file. There was conflicting information obtained during the investigation as a staff member indicated working with children without having provided immunizations while the licensee initially reported a staff member only completed training and was not being counted as staff providing ratio at the facility. However, upon further investigation, the licensee confirmed a staff member indeed worked at the facility without providing documentation for vaccinations. The licensee explained a staff member was at the facility to shadow her and only worked approximately 4-5 hours. A staff member indicated being told they could not

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Karrene Turner	TELEPHONE: 951-970-1161
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 09-CC-20220804113101

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: HORN FAMILY CHILD CARE	FACILITY NUMBER: 334803660
	VISIT DATE: 10/25/2022

NARRATIVE

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return to work without the requested immunizations, which the licensee confirmed. Per Health and Safety Code 1597.622 (a)(2), if a person meets all other requirements for employment or volunteering, as applicable, but needs additional time to obtain and provide his or her immunization, the person may be employed or volunteer conditionally for a maximum of 30 days upon signing and submitting a written statement attesting that he or she has been immunized as required.

Based on all the information obtained from pertinent parties, documentation, records review during inspection, the department has determined the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Please see 809-D for deficiency.

Exit interview conducted and report was reviewed with the licensee, Jessica Horn. A Notice of Site Visit, appeal rights and a copy of this report was provided to the licensee. The Notice of Site Visit must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Karrene Turner	TELEPHONE: 951-970-1161
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC9099 (FAS) - (06/04)

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Control Number 09-CC-20220804113101

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: HORN FAMILY CHILD CARE	FACILITY NUMBER: 334803660
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/25/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/01/2022 Section Cited HSC 1597.622(a)(2)	1 2 3 4 5 6 7	If a person meets all other requirements for employment or volunteering...but needs additional time to obtain and provide his or her immunization, the person may be employed or volunteer conditionally for a maximum of 30 days upon signing and submitting a writtne statement attesting [they]	1 2 3 4 5 6 7	Licenee agrees to submit a memo of understanding of the regulation and how it will be implemented at the facility to the LPA by 11/01/2022..
	8 9 10 11 12 13 14	have been immunized as required. Licensee indicated a staff member did not have immunizations and would not return to work until receiving proof of immunizations. A staff member reported licensee informed them they could not return after 1 day of work until immunizations were received.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Aaron Ross	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Karrene Turner	TELEPHONE: 951-970-1161
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC9099 (FAS) - (06/04)

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