334845123-6-10-2021-09-CC-DHOE-C3UQVY-20210610123108

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334845123
Report Date: 06/10/2021
Date Signed: 06/10/2021 12:31:18 PM

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:	BOROSKI FAMILY CHILD CARE		FACILITY NUMBER:	334845123
ADMINISTRATOR:	BOROSKI,MISHELL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 488-4255
CITY:	CHERRY VALLEY	STATE: CA	ZIP CODE:	92223
CAPACITY:	14	CENSUS: 9	DATE:	06/10/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Licensee, Mishell Boroski		TIME COMPLETED:	12:30 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 06/10/2021 at 09:05am, Licensing Program Analyst (LPA) Destinee Hogue arrived at the facility to conduct a required annual inspection. LPA Hogue toured the facility inside and outside, took census of daycare children present on this date, verified facility associations, and discussed the following with Licensee, Mishell Boroski. Normal days and hours of operation are: Monday-Friday from 6:00am to 6:00pm OFF-LIMIT AREAS INCLUDE: Master bedroom, master bathroom, backyard, jacuzzi, and outdoor shed · There is a spa located on the left side of the backyard. Spa is covered, Wooden fencing surrounds the spa and the fencing gate is secured with a key-lock. 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. · 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. · Storage areas for poisons are observed to be inaccessible and locked. · All hazardous items were not observed to be inaccessible, this includes; detergents, cleaning compounds, medications, and other items. During LPA's tour of the facility, LPA observed toothpaste being stored and accessible in daycare bathroom drawers and cabinet; water hose in daycare outdoor play space is unraveled on the ground in children's outdoor play area (side of the house); an open Budlight Platinum beer can was observed on the ground in the front yard outdoor play area, along with dog or cat feces was observed on the ground in the front yard outdoor play area. During this inspection, an Advisory Note-Technical Violation was issued to Licensee. · There is a properly barricaded fire place · Appropriate fire extinguisher, smoke detector and carbon monoxide detector is present and were tested by the applicant during this inspection

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee Hogue	TELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021

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: BOROSKI FAMILY CHILD CARE	FACILITY NUMBER: 334845123
	VISIT DATE: 06/10/2021

NARRATIVE

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· Home is clean and orderly, with heating and ventilation for safety and comfort
· Facility is a single-story residence
· Safe and appropriate toys and equipment are present for both indoor and outdoor activities.
· A working telephone is present
· Infant Safe Sleep Regulation, 102425 were reviewed with the Licensee during this inspection.
· Clean, safe and age appropriate toys
· Licensee was present at the facility and understands when temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children
· Licensee agreed to ensure that children in care are supervised at this time.
· Outdoor play areas are fenced, and appropriate supervision was observed at the time of this inspection.
· The facility is operating within the licensed capacity and appropriate ratios were observed at the time of this inspection.
· Each child’s file contains a copy of the emergency information card with required information
· AB 1207 Mandated Child Abuse Reporter Training completed on 10/13/2020 and 04/28/2021
· Required immunization record on file for licensee and assistant(s)
· 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 06/10/2021.
· Any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice.
· Pediatric CPR and First Aid Card expired on 07/12/2018. LPA Hogue issued an Advisory Note-Technical Violation during this inspection.
· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov
· 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
· The Duty Officer is available to answer questions Monday – Friday from 8:00am to 5:00pm at (951)782-4200

The following was discussed with Licensee:
· AB2370 – Effective January 1, 2019 – Lead Poisoning – providers are required to provide a lead toxicity prevention handout to parents/guardians of newly enrolled and newly reenrolled children with information on risks and effects of lead poisoning; blood lead testing recommendations and requirements; and options for obtaining blood lead testing, including free and/or discounted testing.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee Hogue	TELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021

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: BOROSKI FAMILY CHILD CARE	FACILITY NUMBER: 334845123
	VISIT DATE: 06/10/2021

NARRATIVE

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There will be a training component of this added to the Preventative Health Training beginning July 1, 2020.

· AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – In accordance with California Health and Safety Code Section 1596.8662 – requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. Existing licensees must meet requirements by March 30, 2018. New employees shall have 90 days to complete training as required. This training requirement may be directly met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/ and are provided in English and Spanish. If no training is made available in a required person’s primary language, then those persons shall be exempt from this requirement

· - AB2231 (2016) – Increased Civil Penalties, effective July 1, 2017 – For failing to correct a violation the civil penalty is increased to $100 per day for EACH violation until corrected; For failing to correct a repeated violation the civil penalty is increased to $250 immediately assessed , and $100 per day afterwards for EACH repeated violation until corrected; For an Immediate Risk violation the civil penalty is increased to $500 immediately assess, and $100 per day for EACH violation after that until corrected; For any repeated Immediate Risk violations the civil penalty is increased to $1,000 immediately assess, and $100 per day afterwards for EACH repeated violation until corrected. NOTE: Repeat violations are defined as a violation of a previously cited statutory or regulatory Section and/or subsection within 12 months prior.
· Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov

During the exit interview, the Licensee, Mishell Boroski confirmed that there are 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.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee Hogue	TELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021

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: BOROSKI FAMILY CHILD CARE	FACILITY NUMBER: 334845123
	VISIT DATE: 06/10/2021

NARRATIVE

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A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS.

LPA Hogue explained to Licensee that no deficiencies were cited during this inspection, however an Advisory Note-Technical Violation and Advisory Note-Technical Assistance was issued to Licensee during this inspection.

A copy of this report was provided to the licensee on this date and must be made available to the public upon request for the next 3 years.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee Hogue	TELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021

LIC809 (FAS) - (06/04)

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