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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845343
Report Date: 06/01/2022
Date Signed: 06/01/2022 11:05:07 AM


Document Has Been Signed on 06/01/2022 11:05 AM - 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 STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:KING FAMILY CHILD CAREFACILITY NUMBER:
334845343
ADMINISTRATOR:KING,TAILESHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 518-5169
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY:14CENSUS: DATE:
06/01/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tailesha KingTIME COMPLETED:
11:20 AM
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An office meeting was held at the Riverside Child Care South East Regional Office with Licensing Program Manager (LPM) Carlos Martinez, Licensing Program Analyst (LPA) Sumayya Habeebulla and Tailesha King, Licensee. The purpose of the office meeting was to discuss the Decision & Order issued by the department that became effective on April 14, 2022.

During the meeting, LPM Martinez discussed the Decision & Order, including the terms and condition of the probationary period which is in effect for 3 years. The following terms were discussed with the Licensee:

1. The family child care home license is suspended for six months from February 26, 2021 – No longer in effect (August 26, 2021).

2. During probation, the Licensee shall obey all state and federal laws, including those laws and regulations pertaining to the operation of a child care home.

3. Within 24 hours or by the close of business, the Licensee will notify the department by telephone and in writing of any criminal charges filed against her or arrests against her or members of her household.

4. The Licensee shall timely report to the department and to the parents or guardians of any child in care any incident for which reporting is required in accordance with the laws and regulations pertaining to the operation of a child care home.

5. The Licensee will be available to be interviewed by any department representative and fully cooperate with department staff.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Sumayya HabeebullaTELEPHONE: 951-201-1991
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: KING FAMILY CHILD CARE
FACILITY NUMBER: 334845343
VISIT DATE: 06/01/2022
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6. During probation, the Licensee must notify the parents or guardians of all children in care of the probationary status of her license. She shall give parents or guardians, in person or by mail, a true, correct, and complete copy of this Decision and Order, and shall obtain a written receipt from each of them that states they have received a copy of this Decision and Order. The Licensee shall retain a copy of all the receipts for review by the department during the term of probation.

7. As directed by the department, the Licensee will take and successfully complete 3 hours of education on topics related to the operation of a family child day home and licensure with the department.

8. If the Licensee fails to comply with any of the terms and conditions of probation, then the department may institute further proceedings to vacate the stay of the revocation of the license, or otherwise discipline the
Licensee. No such action shall be taken without notice to the Licensee, so that she has an opportunity to appear and defend her license; any hearing shall be subject to those statutes and regulations governing disciplinary actions against child care home facility licensees. This does not, however, restrict the department's power to issue an interim or temporary suspension order that otherwise complies with the law.

9. LPM Martinez reviewed self generated LIC 9244.


Tailesha King, Licensee, agrees to operate the facility in full compliance with Title 22 and Health & Safety Code Regulations and adhere to the terms and conditions of the Decision and Order. Per terms of the Order, upon successful completion, the License shall be restored to its unrestricted capacity.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Sumayya HabeebullaTELEPHONE: 951-201-1991
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022
LIC809 (FAS) - (06/04)
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