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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360920824
Report Date: 09/03/2024
Date Signed: 09/03/2024 05:07:16 PM


Document Has Been Signed on 09/03/2024 05:07 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:TUCKER FAMILY CHILD CAREFACILITY NUMBER:
360920824
ADMINISTRATOR:BRENDA TUCKERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 793-6645
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY:14CENSUS: 8DATE:
09/03/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Brenda Tucker, LicenseTIME COMPLETED:
05:15 PM
NARRATIVE
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On 09/03/2024 at 03:00 PM, Licensing Program Analyst (LPA) Raymond Moorehead arrived at the facility to conduct a required/annual inspection as part of a compliance review. LPA toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed:

Normal days and hours of operation are: Monday through Friday, from 7:30 AM to 5:30 PM

OFF-LIMIT AREAS INCLUDE: 1st Floor bedrooms, Laundry room, Entire 2nd Floor, Pool area, Garage.

The facility is operating within the licensed capacity and appropriate ratios.


· Appropriate supervision was provided during this inspection.

· A working telephone is present and is the current number on file.

· Appropriate fire extinguisher, smoke detector and carbon monoxide detector were present and tested by the Licensee during this inspection.

· Fireplace is properly screened to prevent access by children.

· All hazardous items are stored inaccessible to children.

· Toxins are locked.

· Weapons are not present/stored in the home, according to Licensee. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations

· Children do not have access to stairs. Licensee has a gate that is placed on the stairs whenever children are in the area near the stairs. Children were observed to be in the main play area in which has a gate that prevents access from the area in which the stairs are present.

· Verification of control of property is on file.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Raymond MooreheadTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/03/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: TUCKER FAMILY CHILD CARE
FACILITY NUMBER: 360920824
VISIT DATE: 09/03/2024
NARRATIVE
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· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights posters are posted.

· Mandated Reporter Training Certificate expires on 02/25/2025 (Licensee) and on 03/12/2025 (Assistant)

· Pediatric CPR and First Aid Card expires on 03/2025 (Licensee and Assistant)

· Health & Safety Certificate - completed

· There is an in-ground pool that is surrounded by mesh fencing. The fence surrounds the entire pool, the gate is self-closing, self-latching, and opens away from the pool. The pool's fence is locked by a dial lock. LPA and Licensee's spouse tested the gate during today's visit. 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 were observed at the time of the visit.

· Current roster is on file.

· Documentation of fire and disaster drills are on file – Last documented drill was conducted on 08/11/2023

· Children’s records are not complete.

· Employee’s records are complete.

· 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

· Resident and/or staff records reviewed on 09/03/2024 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.

· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

- LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Raymond MooreheadTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: TUCKER FAMILY CHILD CARE
FACILITY NUMBER: 360920824
VISIT DATE: 09/03/2024
NARRATIVE
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- LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

- This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information , see PIN 22-02-CCP. 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

- Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

- Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at:


https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200

The licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

Exit interview conducted and report was reviewed with the licensee. Appeal rights were discussed and provided to the licensee. A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. See LIC809-D for cited deficiencies.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Raymond MooreheadTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 09/03/2024 05:07 PM - 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: TUCKER FAMILY CHILD CARE
FACILITY NUMBER: 360920824

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the Licensee did not comply with the section cited above in which poses a potential safety risk to persons in care. During record review, LPA observed that the last fire/disaster drill was conducted/documented on 08/11/2024.
POC Due Date: 09/10/2024
Plan of Correction
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Licensee agrees to conduct a fire/disaster drill with all children in care by 09/10/2024. Further, Licensee agrees to submit proof of completion of the fire/disaster drill to LPA via email. Licensee agrees to document the drill conducted and provide proof to LPA. Licensee agrees to conduct fire/disaster drills at least once every 6 months.
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in which poses a potential health and safety risk to persons in care. During today's visit, LPA observed a infant sleeping in a playpen with a bib and sound device.
POC Due Date: 09/10/2024
Plan of Correction
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Licensee agrees to submit a written statement of understanding to LPA acknowleding that she understands the Title 22 Regulations in regards to Infant Safe Sleep and loose articles in cribs or playpens by 09/10/2024. Licensee may submit the plan of correction to LPA via email, fax, mail, or text message. Email POC to: Raymond.Moorehead@dss.ca.gov
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: Aaron RossTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Raymond MooreheadTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 09/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/03/2024
LIC809 (FAS) - (06/04)
Page: 4 of 7


Document Has Been Signed on 09/03/2024 05:07 PM - 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: TUCKER FAMILY CHILD CARE
FACILITY NUMBER: 360920824

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in which poses a potential health or safety risk to persons in care. During record review, LPA observed that LIC 995A is missing for C6. LIC 627 is missing for C3 and C4. Documentation of immunizations is missing for C6.
POC Due Date: 09/10/2024
Plan of Correction
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Licensee agrees to obtain a completed and signed mentioned forms from the parent/guardian of C3, C4, and C6 by 09/10/2024. Licensee may submit the plan of correction to LPA via email, fax, mail, or text message. Licensee was provided with a blank copy of the requested forms. Email POC to: Raymond.Moorehead@dss.ca.gov

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: Aaron RossTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Raymond MooreheadTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 09/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/03/2024
LIC809 (FAS) - (06/04)
Page: 5 of 7


Document Has Been Signed on 09/03/2024 05:07 PM - 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: TUCKER FAMILY CHILD CARE
FACILITY NUMBER: 360920824

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses a potential health and safety risk to persons in care. During record review, LPA observed that C4 did not have a LIC 9227 on file.
POC Due Date: 09/10/2024
Plan of Correction
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Licensee agrees to obtain a completed and signed LIC 9227 from the parent/guardian of C4 by 09/10/2024. Licensee may submit the plan of correction to LPA via email, fax, mail, or text message. Licensee was provided with a blank copy of LIC 9227. Email POC to: Raymond.Moorehead@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Aaron RossTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Raymond MooreheadTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 09/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/03/2024
LIC809 (FAS) - (06/04)
Page: 6 of 7