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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845683
Report Date: 10/28/2022
Date Signed: 10/28/2022 11:22:12 AM


Document Has Been Signed on 10/28/2022 11:22 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:YISRAEL FAMILY CHILD CAREFACILITY NUMBER:
334845683
ADMINISTRATOR:SARAHYAH YISRAELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 609-7876
CITY:SAN JACINTOSTATE: CAZIP CODE:
92582
CAPACITY:14CENSUS: 6DATE:
10/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sarahyah YisraelTIME COMPLETED:
11:30 AM
NARRATIVE
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At 10:00AM on October 28, 2022, Licensing Program Analyst (LPA) Alaina Wilburn arrived at the facility, to conduct a Case Management inspection. Upon arrival, LPA met with Licensee Sarahyah Yisrael. The purpose of today's visit is to obtain a copy of the current Children Roster, and identify the Licensee's number of children and their ages.

LPA conducted a tour of the entire facility and observed the licensee's children present during the inspection. LPA observed two adult children who are not on the facility Personnel Summary Report. LPA provided Licensee with an LIC 279 (Application for a Family Child Care Home License) and an LIC 279B, and they were updated during the visit. Licensee advised of her enrollees, she has day time children and afternoon children, who attend day care on different days and different times of the day.

The facility is being cited in accordance with Title 22 Family Child Care Home Regulations, Division 12, Chapter 1, Section 102370 (d): Criminal Record Clearance. This posed an immediate risk to the health, safety, or personal rights to the children in care. See LIC809D for cited deficiency.

Exit interview conducted. A copy of this report, Civil Penalty Assessment (LIC 421BG), and appeal rights were discussed and provided to the licensee Sarayah Yisreal on this date.

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 ALONG WITH A COPY OF THE TYPE A DEFICIENCY (809D) CITED DURING THIS INSPECTION. A COPY OF THE TYPE A DEFICIENCY CITED DURING THIS 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.
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2022
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 10/28/2022 11:22 AM - 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 STREET, STE 700
RIVERSIDE, CA 92501


FACILITY NAME: YISRAEL FAMILY CHILD CARE
FACILITY NUMBER: 334845683

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/31/2022
Section Cited

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Criminal Record Clearance (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:

The requirement is not met as evidenced by:
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The Licensee has 2 adult children who are not fingerprint cleared and associated to the facility Personnel Summary Report, which poses an immediate health, safety or personal rights risk to children in care.
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For S2, Licensee will complete an LIC 9163 and have her live scanned ASAP, and submit proof to LPA. During today's visit, Licensee submitted an update LIC 279, to add adult children to form. In addition, Licensee will submit a current TB test and LIC 508s for both children. Civil penalties assessed.

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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: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2022
LIC809 (FAS) - (06/04)
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