334843705-4-7-2022-09-CC-GCAO-CD9VKA-20220407163001

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334843705
Report Date: 04/07/2022
Date Signed: 04/07/2022 04:30:08 PM

Document Has Been Signed on 04/07/2022 04:30 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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	KNOWLES FAMILY CHILD CARE		FACILITY NUMBER:	334843705
ADMINISTRATOR:	CRYSTAL KNOWLES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 682-9066
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92508
CAPACITY:	14	CENSUS: 6	DATE:	04/07/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Crystal Knowles, Licensee		TIME COMPLETED:	04:30 PM

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On 04/07/2022 at 3:45PM a case management visit was completed by Licensing Program Analysts (LPAs) Giselle Carbullido and Justin Giese due to deficiencies found during the course of another inspection.

1) Criminal Record Clearance: Facility has 2 uncleared adults living in the providers home and one adult is excluded.

SEE LIC 809-D for the deficiencies cited.

LPAs, Giselle Carbullido and Justin Giese informed Licensee, Crystal Knowles that this report dated 04/07/2022 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPAs, Giselle Carbullido and Justin Giese informed the Licensee, Crystal Knowles to provide a copy of this licensing report dated 04/07/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

The Licensee was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights.

An exit interview was conducted, a copy of this report and Notice of Site Visit was provided to the Licensee and the LPAs observed the Notice of Site Visit form was posted by staff. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THREE YEARS.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

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 04/07/2022 04:30 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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KNOWLES FAMILY CHILD CARE	FACILITY NUMBER: 334843705
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/07/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/08/2022 Section Cited	1 2 3 4 5 6 7	102370(c)(2) Criminal Record Clearance (2) The licensee shall submit these fingerprints to the California Department of Justice along with a second set of ...102370(j) prior to the individual's employment, residence, or initial presence in the child care home. This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	Based upon LPA interviews the facility did not meet the section above in that there are 2 adults living in the home not associated to the facility and one adult is excluded. Licensee acknowleded both aduts are living at the facility. This is an immediate health and safety risk to children in care.	8 9 10 11 12 13 14
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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: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

LIC809 (FAS) - (06/04)

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