334840663-3-2-2022-09-CC-KPHS-CC5Q7U-20220302105543

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334840663
Report Date: 03/02/2022
Date Signed: 03/02/2022 10:56:01 AM

Document Has Been Signed on 03/02/2022 10:56 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	COX FAMILY CHILD CARE		FACILITY NUMBER:	334840663
ADMINISTRATOR:	COX, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 314-3470
CITY:	CORONA	STATE: CA	ZIP CODE:	92882
CAPACITY:	14	CENSUS: 0	DATE:	03/02/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Maria Cox, Licensee		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	Licensing Program Analysts, Kay Phillips and Taadhimeka Zeiglers arrived at the facility to conduct a Case Management visit. LPAs toured the facility took census, and met with Licensee, Maria Cox. The facility was placed on inactive status, however the Licensee has requested to place the facility on active status at this point. The following was observed during this visit: · Appropriate fire extinguisher and smoke detector present · Off limit areas include garage and 3 bedrooms. · All hazardous items inaccessible · Toxins locked · No guns or weapons present as stated by the Licensee. · Single story home · The fireplace is properly screened · Verification of control of property on file · Facility Sketch and Emergency Disaster Plan are posted · Pediatric CPR and First Aid Card - expire on 08/15/2023 · Health & Safety Certificate on file · Above ground spa with hard cover and lock · Clean, safe and age appropriate toys · Mandate report training certificate - expires 08/2023

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Karrene Phillips	TELEPHONE: 951-970-1161
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022

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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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: COX FAMILY CHILD CARE	FACILITY NUMBER: 334840663
	VISIT DATE: 03/02/2022

NARRATIVE

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The following was discussed with the Licensee(s):
- 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

- AB 633 – Parent Notification Requirements effective January 1, 2007 – were explained during this visit. Parent Notification Requirements form LIC 9224 (12/06) & AB 633 Fact Sheet left at facility.
- Responsibilities of being a mandated reporter
- Access to forms & Regulations for Family Child Care 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 with the licensing office at all times
- Smoking tobacco in a family child care home during the hours of operation is prohibited
- Baby walkers, bouncy seats, excersaucers 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
- Criminal record clearances 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.
- AB 978 – Zero Tolerance Related Regulations went into effect January 18, 2011 – In accordance with California Health and Safety Code Sections 1596.99(c)/1597.58(c) – it was explained that an immediate $150 Civil penalty will be assessed for each serious violation and a civil penalty of $150 per day per violation will be assessed until corrected.
- Once licensed, the Notice of Site Visit must be posted 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.

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Karrene Phillips	TELEPHONE: 951-970-1161
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: COX FAMILY CHILD CARE	FACILITY NUMBER: 334840663
	VISIT DATE: 03/02/2022

NARRATIVE

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- The Duty Officer is available to answer questions Monday – Friday at (951) 782-4200.
· AB 2084 – Nutritious Beverages in Child Care Facilities went into effect January 1, 2012- In accordance with California Health and Safety Code Section 1596.808- licensee was informed of this new law during this visit.

Unusual Incident Reports are emailed to UnusualIncidentReportsDO09@dss.ca.gov

An exit interview was conducted and a copy of this report was provided to the Licensee on this date.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.
A copy of this report must be made available to the public for 3 years.

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Karrene Phillips	TELEPHONE: 951-970-1161
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022

LIC809 (FAS) - (06/04)

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