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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843705
Report Date: 05/17/2022
Date Signed: 05/17/2022 01:44:25 PM


Document Has Been Signed on 05/17/2022 01:44 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 CAREFACILITY NUMBER:
334843705
ADMINISTRATOR:CRYSTAL KNOWLESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 682-9066
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY:14CENSUS: 0DATE:
05/17/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Crystal Knowles, LicenseeTIME COMPLETED:
01:50 PM
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An Informal Meeting was held at the Riverside Child Care Regional Office on this date, May 17, 2022 at 12:30PM. Present in the conference were Licensee, Crystal Knowles; Stephanie Scott, Adult Resident; Licensing Program Manager (LPM), Gilbert Sena and Licensing Program Analyst (LPA), Giselle Carbullido.

The meeting was held to discuss the facility's most recent deficiencies of Title 22 Regulations pertaining to Criminal Record Clearance, Safe Sleep Regulations, Children’s Records, and Staff Requirements. Facility's compliance history was reviewed during this conference.

During the meeting, Care and Supervision, Operation of a Family Child Care Home, and Reporting Requirements were also discussed. It was disclosed that the following measures have been taken by the Licensee:

1. Submitted statement of understanding for Criminal Record Clearance

2. Completed an updated 279A and 279B for children and adults living in the home

3. Beginning process for assistant to complete health and safety certificate.

4. Acquired clearance and Associations for 2/3 adults needed for plan of corrections and is in process of seeking transfer of exemption for third adult.

The Licensee was provided with the following CDSS resources during this visit:

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2022
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: KNOWLES FAMILY CHILD CARE
FACILITY NUMBER: 334843705
VISIT DATE: 05/17/2022
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1. Information for ongoing training and regulations: https://www.cdss.ca.gov

2. CDSS Videos- https://ccld.childcarevideos.org/ or https://ccld.childcarevideos.org/family-child-care-providers/

3. CDSS PINS at: https://www.cdss.ca.gov/inforesources/community-care-licensing/policy/provider-information-notices/child-care

4. LIC form 9224: Acknowledgement of Receipt of Licensing Reports

5. Copies of Regulations: 102417 Operation of a family childcare home and 102423 Personal Rights

6. Additionally, LPM and LPA introduced the Child Care Technical Support Program (TSP) and informed Licensee that TSP is a voluntarily program to assist facilities with meeting and maintaining the requirements of operating a licensed child care facility. Licensee agreed to submit a written update on whether the facility will voluntarily participate in TSP.

LPM Sena reminded Knowles of the importance for regulatory compliance in licensed facilities to protect the Health and Safety of children in care. Ms. Knowles was informed the Community Care Licensing Agency takes these violations seriously, and how the violations can lead to further administrative actions by the Department.

An exit Interview was conducted with Licensee, Crystal Knowles. LPA Carbullido provided Ms. Knowles with a copy of this report during this office visit on May 17, 2022.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022
LIC809 (FAS) - (06/04)
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