334843705-4-12-2022-09-CC-GCAO-CDEQUD-20220412122834

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334843705
Report Date: 04/12/2022
Date Signed: 04/12/2022 12:28:46 PM

Document Has Been Signed on 04/12/2022 12:28 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: 3	DATE:	04/12/2022
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Crystal Knowles. Licensee		TIME COMPLETED:	12:35 PM

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On date 04/12/2022 at 11:15AM Licensing Program Analyst (LPA) Giselle Carbullido, conducted a case management visit on this date to ensure the compliance of verification of removal for 2 uncleared adults currently living in the facility and correction for civil penalty assessed from prior visit on 04/07/2022. LPA was greeted by Licensee, Crystal Knowles and Shawn Knowles.

An inspection of the home was conducted with three children present. The removal of uncleared adults was addressed by having the adults return to their home address. LPA observed at 11:35 AM that the 2 uncleared adults from visit on 4/7/22 are not present, including one adult with an excluded status. Licensee submitted a statement of compliance and has associated one adult to the facility at time of this visit. Verification of removal is complete for excluded adult.

During today’s visit a corrected LIC421CBG Civil Penalty was provided to Licensee due to technical difficulties from prior visit on 04/07/2022 resulting in an inaccurate calculation of amount assessed for the uncleared individuals.

Additionally, upon tour of the facility at 11:25AM, LPA observed a third uncleared adult living in the home. See LIC809D for deficiency. A civil penalty has been issued for repeat violation.

Based on review and direct observation of the day care home/facility there is a deficiency being cited.

Also, LPA Giselle Carbullido informed the Licensee, Crystal Knowles that a copy of this licensing report dated 04/12/2022 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 that are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

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 04/12/2022 12:28 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: 04/12/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/13/2022 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 fingerprints for the purpose of searching the records of the Federal Bureau of Investigation, or comply with Section 102370(j) prior to the individual's employment, residence, or initial presence in the child care home.
	8 9 10 11 12 13 14	Based upon LPA direct observation the facility did not meet the section above in that that there is a 3rd adult living in the home not fingerprint cleared or associated to the facility. This is an immediate health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: 04/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

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: KNOWLES FAMILY CHILD CARE	FACILITY NUMBER: 334843705
	VISIT DATE: 04/12/2022

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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 LPA 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: 04/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

LIC809 (FAS) - (06/04)

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