334818758-7-22-2019-09-CC-JHUH-BEBP3A-20190722105713

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334818758
Report Date: 07/22/2019
Date Signed: 07/22/2019 10:57:29 AM

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	KIRKWOOD FAMILY CHILD CARE		FACILITY NUMBER:	334818758
ADMINISTRATOR:	KIRKWOOD, DENETTE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 549-1813
CITY:	CORONA	STATE: CA	ZIP CODE:	92880
CAPACITY:	14	CENSUS: 11	DATE:	07/22/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:02 AM
MET WITH:	DENETTE KIRKWOOD		TIME COMPLETED:	11:00 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	On date and time noted, Licensing Program Analyst (LPA) John Huynh conducted a Random Annual Inspection using the Inspection Tool as part of the Inspection Tool Pilot Project. This Inspection tool consists of a short staff interview; a review of both the physical plant, operation and records. The results of these reviews will be put into the standard inspection domain tools based upon this initial review, the inspection tool will determine whether a more comprehensive inspection is required into any one or more domains (you may refer to the Pilot Operations Program Manual located on the ccld.ca.gov website under Inspection Process Project and Child Care for more details). Following this inspection, the Licensee will be asked to sign the report acknowledging receipt. This report will be uploaded onto the transparency website. All appeal rights will apply to this report and explained to the licensee or representative during the exit interview. The Licensee will be sent a survey to provide their feedback on this inspection tool and this process. Present during this visit were the Licensee, Denette Kirkwood and assistant, Maria Castillo. Licensing Program Analyst (LPA) John Huynh toured the facility, inside and out, records were reviewed, and the following was observed: Normal days and hours of operation are: Monday thru Friday, 6:45AM to 6:00PM. OFF-LIMIT AREAS INCLUDE: The complete upstairs. The inspection consisted of reviews of the following domains: · Physical Plant · Care and Supervision

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: John Huynh	TELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019

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 7

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KIRKWOOD FAMILY CHILD CARE	FACILITY NUMBER: 334818758
	VISIT DATE: 07/22/2019

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

- Responsibilities of being a mandated reporter
- Baby walkers, bouncy seats, exersaucers and other similar items are prohibited
- The applicant is urged visit the U.S. Consumer Product Safety Commission webpage at www.cpsc.gov to ensure that equipment purchased for the day care has not been recalled
- Once licensed, the Notice of Site Visit will be posted in a prominent location at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also be posted for 30 days. A civil penalty of $100 per violation will be assessed for noncompliance.
- Access to forms & Regulations for Family Child Care online at www.ccld.ca.gov.
- Please subscribe by sending an email to childcareadvocatesprogram@dss.ca.gov and requesting to be added to the email list to receive Department updates. They will be sent directly to your e-mail account. Updates can also be accessed through www.ccld.ca.gov
- The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

During the exit interview, the LICENSEE, Denette Kirkwood confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.
See LIC809D for cited deficiencies.
Appeal rights were discussed and a copy of this report was provided to the licensee on this date.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS. A copy of this report was provided to the applicant on this date and must be made available to the public upon request for the next 3 years.

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: John Huynh	TELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019

LIC809 (FAS) - (06/04)

Page: 7 of 7

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KIRKWOOD FAMILY CHILD CARE	FACILITY NUMBER: 334818758
	VISIT DATE: 07/22/2019

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

- AB2231 (2016) – Increased Civil Penalties, effective July 1, 2017 – For failing to correct a violation the civil penalty is increased to $100 per day for EACH violation until corrected; For failing to correct a repeated violation the civil penalty is increased to $250 immediately assessed , and $100 per day afterwards for EACH repeated violation until corrected; For a Zero Tolerance violation the civil penalty is increased to $500 immediately assess, and $100 per day for EACH violation after that until corrected; For any repeated Zero Tolerance violation the civil penalty is increased to $1,000 immediately assess, and $100 per day afterwards for EACH repeated violation until corrected.
NOTE: Repeat violations are defined as a violation of a previously cited statutory or regulatory Section and/or subsection within 12 months prior.
- Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov
- SB420 Effective January 1, 2017 – State summary criminal history information – Information provided to the Department shall include sentencing information.
- AB2370 – Effective January 1, 2019 – Lead Poisoning – providers are required to provide a lead toxicity prevention handout to parents/guardians of newly enrolled and newly reenrolled children with information on risks and effects of lead poisoning; blood lead testing recommendations and requirements; and options for obtaining blood lead testing, including free and/or discounted testing. There will be a training component of this added to the Preventative Health Training beginning July 1, 2020.

- Access to forms & Regulations for Family Child Care Homes online at www.ccld.ca.gov
- Responsibility to know the regulations for anyone providing care
- Inaccessibility of hazards must be constantly reassessed depending on the children in care
- Current facility’s phone numbers must be on file at all times.
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.
- Documentation of fire & earthquake drills to be conducted every six months

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: John Huynh	TELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019

LIC809 (FAS) - (06/04)

Page: 6 of 7

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KIRKWOOD FAMILY CHILD CARE	FACILITY NUMBER: 334818758
	VISIT DATE: 07/22/2019

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

·Facility is not currently providing IMS at this time. 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
· For more information on SIDS and Safe Sleep Environments, please visit:
California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Risk-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep

The following was reviewed with the licensee(s):

- SB792 – Immunization requirements for staff, volunteers, effective September 1, 2016 – In accordance with California Health and Safety Code Section 1597.622(a)(1) - 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 or they may provide a statement declining the vaccination. If employees/volunteers are receiving the influenza vaccination, they must do so between August 1 and December 1 of each year.

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: John Huynh	TELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019

LIC809 (FAS) - (06/04)

Page: 5 of 7

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KIRKWOOD FAMILY CHILD CARE	FACILITY NUMBER: 334818758
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/22/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(8)

Records - 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.
	Deficient Practice Statement
1 2 3 4	This requirement was not met as evidenced by: LPA observed the roster to be not completed and current. This poses a potential risk to the Health and Safety of children in care.
	POC Due Date: 07/26/2019
	Plan of Correction
1 2 3 4	Licensee agrees to update the roster and provide a copy to the department by 07/26/2019. John.Huynh@DSS.CA.GOV

Type B

Section Cited

CCR

102416.5(e)

Staffing Ratio and Capacity - Staffing Ratio and Capacity

(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).
	Deficient Practice Statement
1 2 3 4	This requirement was not met as evidenced by: Upon LPA's arrival, the licensee was observed to be alone and had 11 (eleven) children in care. Her assistant arrived less than 2 minutes after the LPA had arrived. This poses a potential risk to the Health and Safety of children in care.
	POC Due Date: 07/26/2019
	Plan of Correction
1 2 3 4	Licensee has agreed to submit a Plan of Action statement on how she will prevent this from happening again. Due to the Department by 07/26/2019. John.Huynh@DSS.CA.GOV

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: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: John Huynh	TELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019

LIC809 (FAS) - (06/04)

Page: 3 of 7

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KIRKWOOD FAMILY CHILD CARE	FACILITY NUMBER: 334818758
	VISIT DATE: 07/22/2019

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

·Facility Administration
· Records
· Staffing Ratio and Capacity
· Personal Rights
The inspection found the facility to be in compliance in these domains except as noted on the LIC809D.
· No guns or weapons present as of this date. LICENSEE UNDERSTANDS ALL GUNS, WEAPONS AND AMMUNITION MUST BE KEY-LOCKED SEPARATELY AND MADE INACCESSIBLE PER TITLE 22 REGULATIONS.
· There are no bodies of water as of this date. 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.
· Pediatric CPR and First Aid Card – expired on 04/2019 for Denette Kirkwood
· Health & Safety Certificate - completed on and on file
· All providers, including the licensee, assistant and substitute providers have completed mandated reporter training – Expires on: 02/14/2020 Denette Kirkwood, 02/20/2020 Maria Castillo.
· The licensee understands and shall permit the Department to inspect the family child care home and to privately interview children or staff to determine compliance with or to prevent violations of family child care laws or regulations.
· Criminal record clearances are required prior to all adults living or working in a Family Child Care Home. A civil penalty of $100.00 per day the person has been present, may be assessed.
Resident and/or staff records reviewed on 07/22/2019 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.
· The Licensee WAS NOT operating within her licensed capacity and ratios upon arrival but was corrected during this inspection.

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: John Huynh	TELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019

LIC809 (FAS) - (06/04)

Page: 4 of 7

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KIRKWOOD FAMILY CHILD CARE	FACILITY NUMBER: 334818758
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/22/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(3)

Physical Plant - Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.
	Deficient Practice Statement
1 2 3 4	This requirement was not met as evidenced by: Upon LPA's arrival, LPA observed the stairs were not barricaded and present were children under the age of 5 years old. The children were in an adjacent family room from where the stairs are located. This poses a potential risk to the Health and Safety of children in care.
	POC Due Date: 07/22/2019
	Plan of Correction
1 2 3 4	During the inspection, the barricade was put up making the stairs inaccessible to children in care.

Type B

Section Cited

CCR

102416(c)

Facility Administration - Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
	Deficient Practice Statement
1 2 3 4	This requirement was not met as evidenced by: LPA observed the licensee's CPR/First aid had expired on 04/2019. This poses a potential risk to the Health and Safety of children in care.
	POC Due Date: 08/22/2019
	Plan of Correction
1 2 3 4	Licensee agrees to submit proof of enrollment in CPR/First Aid training that is EMSA certified or submit a copy of the CPR/First Aid card that is EMSA Certified by 08/22/2019. John.Huynh@DSS.CA.GOV

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: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: John Huynh	TELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019

LIC809 (FAS) - (06/04)

Page: 2 of 7