334843668-1-9-2024-09-CC-PORS-CZC3WW-20240109173726

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334843668
Report Date: 01/09/2024
Date Signed: 01/09/2024 05:37:42 PM

Document Has Been Signed on 01/09/2024 05:37 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:	MIXON FAMILY CHILD CARE		FACILITY NUMBER:	334843668
ADMINISTRATOR:	MIXON, MICAELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 534-4594
CITY:	BEAUMONT	STATE: CA	ZIP CODE:	92223
CAPACITY:	14	CENSUS: 8	DATE:	01/09/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Licensee Micaela Mixon		TIME COMPLETED:	05:50 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 date and time listed, Licensing Program Analyst (LPA) Perla Ordones arrived at the facility to conduct a required/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 – Friday; 06:30AM – 06:00PM. OFF-LIMIT AREAS INCLUDE: Entire second floor, downstairs bedroom, and garage. The facility is operating within the licensed capacity and appropriate ratios. · Appropriate supervision provided during this inspection. · A working telephone is present and current number on file. · Appropriate fire extinguisher, smoke detector and carbon monoxide detector present and were tested by the Licensee during this inspection. · Fireplace is properly screened to prevent access by children. · All hazardous items are stored inaccessible to children. · Poisons and toxins are not locked. During the facility tour, LPA observed three cleaning supplies, which fall under the poison category, under the sink in the on-limits kitchen area. The poisons were not stored in a key-locked area per regulations. Licensee corrected this during the visit by moving poisonous items to key locked storage area. · Weapons are not present. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations · Stairs are barricaded.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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 01/09/2024 05:37 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: MIXON FAMILY CHILD CARE	FACILITY NUMBER: 334843668
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(4)(A)

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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as LPA observed three cleaning supplies, which fall under the poison category, under the sink in the on-limits kitchen area. The poisons were not stored in a key-locked area per regulations which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/23/2024
	Plan of Correction
1 2 3 4	During the visit, Licensee corrected this POC by moving poisonous items to key locked storage area. Licensee agrees to read the Operation of a family child care home regulations and write a statement agreeing to maintain all poisons and toxins in a key locked storage area.

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, the licensee did not comply with the section cited above as LPA observed two children, C2 and C3, who had just fallen asleep with blankets and pillows in their play yard which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/23/2024
	Plan of Correction
1 2 3 4	During the visit, Licensee corrected this POC by moving the items from the play pens once it was brought to their attention. Licensee agrees to read the Infant Safe Sleep regulations and write a statement agreeing to follow regulations regarding loose articles in infant sleeping areas.

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) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/09/2024 05:37 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: MIXON FAMILY CHILD CARE	FACILITY NUMBER: 334843668
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(f)

Infant Safe Sleep

An infant shall not be swaddled while in care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as LPA observed C1, who had just fallen asleep, in a sleep sack which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/23/2024
	Plan of Correction
1 2 3 4	During the visit, Licensee removed C1 from the sleep sack once it was brought to their attention when C1 briefly woke up. Licensee agrees to read the infant safe sleep regulations and write a statement agreeing to no longer use sleep sacks at the facility.

Type B

Section Cited

CCR

102417(m)(3)

Operation of A Family Child Care Home

(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state. 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 as LPA observed that C6 and C8 were missing proof of the LIC282 which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/23/2024
	Plan of Correction
1 2 3 4	Deficiency cleared during the visit. Licensee obtained proof of signed LIC282s for C6 and C8 near the visit's completion.

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) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/09/2024 05:37 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: MIXON FAMILY CHILD CARE	FACILITY NUMBER: 334843668
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: 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 as C1, C2, and C6 were missing proof of the 15 minute sleep checks which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/23/2024
	Plan of Correction
1 2 3 4	Licensee agreed to conduct 15 minute sleep checks for C1, C2, and C6. Licensee agreed to send proof of the Plan of Correction (POC) to Community Care Licensing (CCL) by the end of the business day on the POC due date of 01/23/2024.

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) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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: MIXON FAMILY CHILD CARE	FACILITY NUMBER: 334843668
	VISIT DATE: 01/09/2024

NARRATIVE

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· Verification of control of property on file.
· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted.
· Mandated Reporter Training expires on 01/2024. Licensee stated they would be completing the training this month.
· Pediatric CPR and First Aid Card expire on 12/2023. Licensee provided proof of enrollment in new EMSA approved CPR/1^st Aid course.
· Health & Safety Certificate - completed on 11/07/2015.
· 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.
· Clean, safe and age appropriate toys.
· Current roster on file.
· Documentation of fire and disaster drills on file – Last drill conducted on 07/06/2023.
· Children’s records are not complete. During record review, LPA observed that C1, C2 and C6 were missing proof of the 15-minute sleep checks. Additionally, C6 and C8 were missing proof of the LIC282 but Licensee was able to obtain proof for both children towards the visit’s completion.
· Employee’s records are complete.

· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov

· Resident and/or staff records reviewed on 01/09/2024 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.

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

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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: MIXON FAMILY CHILD CARE	FACILITY NUMBER: 334843668
	VISIT DATE: 01/09/2024

NARRATIVE

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During visit, LPA observed two children, C2 and C3, who had just fallen asleep with blankets and pillows in their play yard. Licensee moved the items once it was brought to their attention. Additionally, LPA observed C1, who had just fallen asleep, in a sleep sack. Licensee removed C1 from the sleep sack when the child briefly woke up once it was brought to their attention.

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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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: MIXON FAMILY CHILD CARE	FACILITY NUMBER: 334843668
	VISIT DATE: 01/09/2024

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. 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.

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 LIC809-D for cited deficiencies and technical violations.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

During the exit interview, the LICENSEE Micaela Mixon, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the licensee Micaela Mixon.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC809 (FAS) - (06/04)

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