334844817-7-17-2019-09-CC-JWIN-BE6UUH-20190717155333

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334844817
Report Date: 07/17/2019
Date Signed: 07/17/2019 03:53:52 PM

COMPREHENSIVE INSPECTION

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:	JIMENEZ FAMILY CHILD CARE		FACILITY NUMBER:	334844817
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	07/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Jennifer Jimenez		TIME COMPLETED:	04:00 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 July 17, 2019 at 2:00 pm, Licensing Program Analysts (LPAs) Mariah McCarty, James Wilkerson and Fe Flora arrived at the facility to conduct an annual inspection and capacity increase. LPAs observed and/or discussed: Normal days and hours of operation are: Monday-Friday 6:00am-6:00pm. OFF-LIMIT AREAS INCLUDE: The upstairs area, garage and kitchen. · The facility is operating within the licensed capacity and appropriate ratios · The Licensee is present in the home and has ensured that children in care are supervised at this time · When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children · A working telephone is present · Appropriate fire extinguisher, smoke detector and carbon monoxide detector is present and were tested by the applicant during this inspection. · All hazardous items are inaccessible, this includes: detergents, cleaning compounds, medications and other items which could pose a danger to children · Storage of poisons is inaccessible to children and locked · There is a properly barricaded fire place · No guns or weapons present as stated by the Licensee. Licensee understands all guns, weapons and ammunition must be key-locked separately and made inaccessible per Title 22 regulations. · Stairs were barricaded at this time · Home is clean and orderly, with heating and ventilation for safety and comfort ************************************************Continued on next page**********************************************

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: James Wilkerson	TELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019

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: JIMENEZ FAMILY CHILD CARE	FACILITY NUMBER: 334844817
	VISIT DATE: 07/17/2019

NARRATIVE

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This website can also be accessed through www.ccld.ca.gov
- The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

No deficiencies were cited.

During the exit interview, the LICENSEE, Jennifer Jimenez, confirmed that there were no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

As a REMINDER: when your child(ren) turn 18 years of age, you MUST SUBMIT an updated LIC279, LIC508 and TB Screen and have your child submit for LIVESCAN background clearance. This also applies to any adult PRIOR to them moving into the home or who currently lives in the home. Also, PRIOR to employment of any adult, you must submit the LIC508, TB screening and obtain a background clearance through LIVESCAN.

The following was discussed:

A NOTICE OF SITE VISIT CAN BE ISSUED AND MUST BE POSTED IN A PROMINENT LOCATION AT THE FACILITY FOR THE NEXT 30 DAYS ALONG WITH A COPY OF ALL TYPE A DEFICIENCIES (LIC9099D) CITED DURING INSPECTION. A COPY OF ALL TYPE A DEFICIENCIES CITED DURING INSPECTION MUST ALSO BE IMMEDIATELY (WITHIN 24 HOURS OF THE CHILD’S NEXT DAY IN CARE) GIVEN TO THE PARENTS OF ALL CHILDREN ENROLLED IN THE CHILD CARE FACILITY AND ANY CHILDREN ENROLLED INTO THE CHILD CARE FACILITY OVER THE NEXT 12 MONTHS AT THE TIME OF ENROLLMENT.

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SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: James Wilkerson	TELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019

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: JIMENEZ FAMILY CHILD CARE	FACILITY NUMBER: 334844817
	VISIT DATE: 07/17/2019

NARRATIVE

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- AB 2386 – Carbon Monoxide Detector Regulations, effective January 1, 2015 – In accordance with California Health and Safety Code Section 1975.543 - Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections
- AB 2236 – Civil Penalties, effective July 1, 2015 – Enacts new civil penalties in cases where the Department determines that a violation of licensing standards resulted in the death or serious injury, or constitutes physical abuse of a child in care. The bill establishes an appeal procedure specific to these civil penalties. The bill also expands the scope of the Child Health and Safety Fund in order to assist parents in securing alternative child care when a Child Care Center or Family Child Care Home license has been suspended or revoked. These civil penalty amounts are scaled in relation to the total capacity of all of the licensee’s facilities and not just the specific facility cited or limited to that facility type.
- SB 277 – Immunizations, Personal Beliefs Exemption, effective January 1, 2016 - it eliminates the exemption from existing specified immunization requirements based upon personal beliefs, and only allows an exemption from future immunization requirements deemed appropriate by the State Department of Public Health or a medical professional for medical reasons.
- AB290 – Child Nutrition, effective January 1, 2016 - – In accordance with California Health and Safety Code Section 1596.866 - each family day care home licensee who provides care, shall have at least one hour of childhood nutrition training as part of the preventive health practices course or courses.
- SB792 – Immunization requirements for staff, volunteers, effective September 1, 2016 –
(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

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SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: James Wilkerson	TELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019

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: JIMENEZ FAMILY CHILD CARE	FACILITY NUMBER: 334844817
	VISIT DATE: 07/17/2019

NARRATIVE

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• Safe and appropriate toys and equipment are present for both indoor and outdoor activities.
• Outdoor play areas were fenced or appropriate supervision was present
• Verification of control of property on file
• Property owner/landlord notification and consent on file
• Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted
• Pediatric CPR and First Aid Card expire on 09/23/2019
• Health & Safety Certificate - completed on 09/23/2017
• There are 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
• Documentation of fire drills on file
• Each child’s file contains a copy of the emergency information card with required information
• Criminal record clearances are required prior to all adults living or working in a Family Child Care Home. A civil penalty of $100.00 per day the person has been present, may be assessed. All individuals subject to a criminal record review shall obtain a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. This was verified on 07/17/2019 .
· The Department was granted inspection authority as required by the Health and Safety Code
· Facility is providing IMS This facility provides Incidental Medical Services – IMS at this time. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: James Wilkerson	TELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019

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: JIMENEZ FAMILY CHILD CARE	FACILITY NUMBER: 334844817
	VISIT DATE: 07/17/2019

NARRATIVE

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- Once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also be posted for 30 days. A civil penalty of $100 per violation will be assessed for noncompliance.
- Access to forms & Regulations for Family Child Care Homes online at www.ccld.ca.gov.
- Please subscribe at www.childcareadvocatesprogram@dss.ca.gov to receive Department updates. They will be sent directly to your e-mail account once you have set up an account.

This website can also be accessed through www.ccld.ca.gov
- The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

No deficiencies were cited.

During the exit interview, the LICENSEE, Jennifer Jimenez, confirmed that there were no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.
***************************************Continued on next page***********************************************

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: James Wilkerson	TELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: JIMENEZ FAMILY CHILD CARE	FACILITY NUMBER: 334844817
	VISIT DATE: 07/17/2019

NARRATIVE

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· Facility is not currently providing IMS at this time. Incidental Medical Services (IMS) policy was discussed. 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
· For more information on SIDS and Safe Sleep Environments, please visit:
California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Rick-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep

The following was reviewed with the licensee(s):
- AB 1819 – Smoking prohibition on the premises of Family Child Care Homes, effective January 1, 2015 – This bans smoking tobacco in a home that is licensed as a family child care home, and in those areas of the family child care home where children are present. This change in law was based on demonstrated negative health effects of second and “third hand” smoke on children. Third hand smoke generally refers to the residue from tobacco smoke that sticks to surfaces after the secondhand smoke has cleared.
- AB 2621 – Public information posted on the internet, effective January 1, 2015 – The Department shall post licensing reports for Family Child Care Homes on its Internet Web site.
This information will be updated at least monthly on the website and will span the preceding five-year period.

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SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: James Wilkerson	TELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019

LIC809 (FAS) - (06/04)

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