334806580-10-4-2022-10-CC-LVAA-CJVTH5-20221004144410

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334806580
Report Date: 10/04/2022
Date Signed: 10/04/2022 02:44:30 PM

Document Has Been Signed on 10/04/2022 02:44 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	BORJA FAMILY CHILD CARE		FACILITY NUMBER:	334806580
ADMINISTRATOR:	BORJA, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 398-2667
CITY:	COACHELLA	STATE: CA	ZIP CODE:	92236
CAPACITY:	14	CENSUS: 7	DATE:	10/04/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Maria Borja		TIME COMPLETED:	02:55 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	On 10/04/2022, Licensing Program Analyst (LPA) Lorena Valenzuela arrived at the facility to conduct an annual inspection as part of a compliance review. LPA toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed: · Normal days and hours of operation are: Monday through Friday 6:00am-5:00pm · Off-limit areas include: living room, kitchen, garage, all bedrooms and right side of backyard. · The facility is licensed to have no more than 14 children as a large family child care home and is not operating within the licensed capacity and appropriate ratios. At the time of inspection, licensee had seven children in care all under 4 years old, with two being infants (Child #5 and Child #7). Licensee stated Child #6 was enrolled in school but was not able to provide documentation that Child #6 was enrolled in school at the time of inspection. · Appropriate supervision provided during this inspection · A working telephone is present, and the current phone number is on file · A fully charged fire extinguisher (3A:40BC) was observed. A smoke detector and carbon monoxide detector were present and tested by the Licensee during this inspection. · There is no fireplace in the home · All hazardous items are stored inaccessible to children · Toxins are locked · Weapons are not present per licensee. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations · This is a one story home · Clean, safe and age appropriate toys · Current roster is not on file · Facility Sketch, Emergency Disaster Plan and Notification of Parent’s Rights poster are posted · Documentation of fire and disaster drills on file – Last drill conducted on 09/30/2022.

SUPERVISOR'S NAME: Stephanie Hudak	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lorena Valenzuela	TELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

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 10/04/2022 02:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: BORJA FAMILY CHILD CARE	FACILITY NUMBER: 334806580
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(b)(3)

Staffing Ratio and Capacity

(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (3) More than six and up to eight children, without an additional adult attendant, only if the criteria in Section 1597.44 of the Health and Safety Code are met. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation,interview and record review, the licensee did not comply with the section cited above in that there was seven children in care, with all children being four years or younger and with two children being infants, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/04/2022
	Plan of Correction
1 2 3 4	At time of inspection, one child (Child #6) was picked up by parent.

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: Stephanie Hudak	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lorena Valenzuela	TELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: BORJA FAMILY CHILD CARE	FACILITY NUMBER: 334806580
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(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
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in two out of seven children (Child # 6 and Child #7) which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/11/2022
	Plan of Correction
1 2 3 4	Licensee agrees to complete LIC 700 and LIC 627 for Child #6, and Child #7, and will submit copies to the Department on 10/11/2022.

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in that the licensee did not have a roster on file which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/11/2022
	Plan of Correction
1 2 3 4	Licensee agrees to complete roster and submit roster to the Department on 10/11/2022.

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: Stephanie Hudak	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lorena Valenzuela	TELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: BORJA FAMILY CHILD CARE	FACILITY NUMBER: 334806580
	VISIT DATE: 10/04/2022

NARRATIVE

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No bodies of water at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Verification of control of property is not on file
· Children’s records are not complete. Two of seven children files (Child #6 and Child#7) are missing emergency medical consent or LIC 627 and emergency contact information or the LIC 700. In addition, Child #7 was missing additional required forms.
· Employee’s records are complete
· Mandated Reporter Training was completed on 06/17/2021
· Pediatric CPR and First Aid Card expire on 05/2023
· Health & Safety Certificate - completed on 09/11/2006
· Resident and/or staff records were reviewed and all adults who require caregiver background checks have received all required clearances and/or exemptions.

The licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

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
The Licensee was informed of their reporting requirements and was provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov

The Licensee can submit transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations858@dss.ca.gov

SUPERVISOR'S NAME: Stephanie Hudak	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lorena Valenzuela	TELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: BORJA FAMILY CHILD CARE	FACILITY NUMBER: 334806580
	VISIT DATE: 10/04/2022

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-and-resources/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.
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.
Go to the licensing webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.

The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200.

See deficiency pages for citations issued. Technical Violations (LIC9102TV) and Technical Assistance (LIC 9102TA) were also issued.

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 inspectionprocess@dss.ca.gov. 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.
An exit interview was conducted, and this report was reviewed with the licensee Maria Borjas. Appeal rights were discussed and provided during the exit interview.

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

SUPERVISOR'S NAME: Stephanie Hudak	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lorena Valenzuela	TELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

LIC809 (FAS) - (06/04)

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