334840837-12-5-2023-09-CC-SBRR-CY8T3J-20231205132225

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334840837
Report Date: 12/05/2023
Date Signed: 12/05/2023 01:22:35 PM

Document Has Been Signed on 12/05/2023 01:22 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	KOLB FAMILY CHILD CARE		FACILITY NUMBER:	334840837
ADMINISTRATOR:	KOLB, COLLEEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 231-3059
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92508
CAPACITY:	14	CENSUS: 5	DATE:	12/05/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	10:04 AM
MET WITH:	Colleen Kolb, Licensee		TIME COMPLETED:	01:30 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 12/04/2023 at 10:34 AM Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to conduct an annual inspection. LPA was greeted by Licensee Colleen Kolb and granted entry to tour the facility inside and out. LPA reviewed records and observed and/or discussed the following: The licensee updated the LIC279 Application form to remove adults no longer residing at the facility and to notify of changes to the composition of the home, as well as the updated 279B current children in the home. The licensee agrees to submit the following updated forms to the department on or before 01/05/2024: 1. LIC610A Emergency Disaster Plan 2. Control of property, proof of updated rental agreement. 3. Proof of LIC9163 Request for Livescan Service and receipt; form provided during inspection. 4. TB screening for resident adult (Expected Move in date 01/2024) Normal days and hours of operation are Monday- Friday, 08:00 AM-4:00 PM OFF-LIMIT AREAS INCLUDE: Garage and Entire 2^nd Floor. The inspection consisted of reviews of the following domain: Physical Plant, Care and Supervision, Records, Facility Administration, Staffing Ratio and Capacity, Personal Rights. The inspection found the facility to be in compliance in these domains, except as noted on the LIC809D. · The facility is operating within the licensed capacity and appropriate ratios. A census of 5 children in care. · The Licensee is present in the home and has ensured that children in care are supervised. · When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children and has hired and assistant. · A working telephone is present. · Appropriate fire extinguisher (2A:10BC) in the green, smoke detector and carbon monoxide detector are present and were tested by the Licensee during this inspection on 12/05/2023.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KOLB FAMILY CHILD CARE	FACILITY NUMBER: 334840837
	VISIT DATE: 12/05/2023

NARRATIVE

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· All hazardous items are inaccessible, this includes detergents, cleaning compounds, medications and other items which could pose a danger to children on 12/05/2023.
· Storage of poisons is inaccessible to children and are located in the laundry room and garage, however the garage door was observed by the LPA to have a lower latch which can be opened from the inside of the home. The hallway leading to the designated restroom for childcare is next to the garage door entering the garage.
· There is no fireplace at this facility.
· No guns or weapons present as stated by the Licensee. Licensee Colleen Kolb, understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations.
· Stairs are barricaded on 12/05/2023.
· Home is clean and orderly, with heating and ventilation for safety and comfort.
· Clean, Safe and age-appropriate toys and equipment are present for both indoor and outdoor activities, however on 12/05/2023 at 10:08 AM LPA S.Brewer observed the 2 play yards located in the front activity area to have pillows, blankets and various plush toys inside. See LIC809D for Type B violation. LPA reviewed and provided a copy of the PIN 20-24-CCP for Infant Safe Sleep to the licensee Colleen Kolb.
· Outdoor play areas are fenced and/or appropriate supervision is present.
· Verification of control of property is not on file, due to changes in the composition of the home reported by the licensee.
· Property owner/landlord notification and consent on file.
· Pediatric CPR and First Aid completed on 04/17/2023; Card expires on 04/2025.
· Health & Safety Certificate – 05/15/2011
· Mandated reporter General: 05/17/2022; AB 1207 Child Care Expires: 05/17/2024
· Fire clearance: 07/06/2012
· Documentation of fire & earthquake drills to be conducted every six months: Last drill completed on 08/29/2023 at 11:00 AM with 5 children, relocated to the front yard.
· There are no bodies of water on 12/05/2023. Licensee Colleen Kolb 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.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KOLB FAMILY CHILD CARE	FACILITY NUMBER: 334840837
	VISIT DATE: 12/05/2023

NARRATIVE

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· Children’s files are not complete for a subject child under 12 months of age, present and in care who did not have the LIC9227 Individual Infant Sleep Plan on file.
· Staff’s files are NOT complete where staff was missing mandated reporter General and AB1207 child care specific training certificates. PIN 19-17-CCP provided to the licensee during inspection.
· A review of staff records on 11/30/2023 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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

Licensee Colleen Kolb, 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.

The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov for Riverside Regional Office.

LPA Susan Brewer, discussed the safe sleep regulations with licensee Colleen Kolb 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.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KOLB FAMILY CHILD CARE	FACILITY NUMBER: 334840837
	VISIT DATE: 12/05/2023

NARRATIVE

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LPA S.Brewer, also informed licensee Colleen Kolb 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.

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.

Deficiencies cited for 3 Type B violations this visit.

Civil Penalties were not issued this visit

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

Exit interview conducted and report was reviewed with the licensee Colleen Kolb.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/05/2023 01:22 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KOLB FAMILY CHILD CARE	FACILITY NUMBER: 334840837
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(b)

Infant Safe Sleep

(b) Cribs or play yards shall be free from all loose articles and objects. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above where on 12/05/2023 at 10:08 AM LPA S.Brewer observed the 2 play yards located in the front activity area to have pillows, blankets and various plush toys inside which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/08/2023
	Plan of Correction
1 2 3 4	The licensee agrees to review Title 22 regulations for 102425 Infant Safe Sleep along with facility staff and submit a written statement ensuring the licensee and staff will remain in compliance with the regulation. Proof of the written statement signed by the licensee and staff can be submitted by fax, mail or e-mail on or before 12/08/2023.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. 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 proof of the required Mandated Reporter Training was completed within 90 days of hire for the licensee's assistant, which pose a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/05/2024
	Plan of Correction
1 2 3 4	The licensee agrees to submit proof of the Required Mandated Reporting training cerficates for hired staff on or before 01/05/2023 and submit to the department by fax, mail or e-mail.

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: Kimberly Williams	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/05/2023 01:22 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KOLB FAMILY CHILD CARE	FACILITY NUMBER: 334840837
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(c)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in the licensee failed to ensure the LIC9227 Individual Infant Sleeping Plan was completed with the authorized representative and on file for a subject child in care and under 12 months of age, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/08/2023
	Plan of Correction
1 2 3 4	The licensee agrees to ensure the LIC9227 Individual Infant Sleeping Plan is completed with the authorized representative for a subject child enrolled in care and under 12 months of age and available for reference and review. The licensee also agrees to submit proof of the required LIC9227 form for the subject child to the department by fax, mail or e-mail on or before 12/08/2023 or the next time the child is in care.

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: Kimberly Williams	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC809 (FAS) - (06/04)

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