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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
364804137
Report Date:
10/25/2022
Date Signed:
10/25/2022 03:44:21 PM
Document Has Been Signed on
10/25/2022 03:44 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
CCLD Regional Office
,
3737 MAIN ST., SUITE 700
RIVERSIDE
,
CA
92501
FACILITY NAME:
DAVIS FAMILY CHILD CARE
FACILITY NUMBER:
364804137
ADMINISTRATOR:
SANDRA DAVIS
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(909) 421-3617
CITY:
BLOOMINGTON
STATE:
CA
ZIP CODE:
92316
CAPACITY:
14
CENSUS:
11
DATE:
10/25/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
12:30 PM
MET WITH:
Sandra Davis
TIME COMPLETED:
04:00 PM
NARRATIVE
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On date and time listed above, Licensing Program Analyst (LPA) Justin Giese arrived at the facility to conduct a 1 year required annual inspection. LPA was granted entry by LIcensee, Sandra Davis. LPA toured the facility, inside and out, reviewed records, and observed and/or discussed the following: This is a Large Family Child Care Home, LPA observed 2 children in care at time of arrival. Licensee left the facility and picked up 9 additional children.
Normal days and hours of operation are:
Monday thru Friday, 6:00AM to 6:00PM
OFF-LIMIT AREAS INCLUDE:
The complete upstairs, downstairs laundry room and the garage.
A review of the staff records and review of a sampling of children's records were conducted as part of this evaluation.
The inspection consisted of reviews of the following domains:
• Physical Plant
• Care and Supervision
• Facility Administration
• Records
• Staffing Ratio and Capacity
• Personal Rights
SUPERVISOR'S NAME:
Gilbert Sena
TELEPHONE:
(951) 782-4200
LICENSING EVALUATOR NAME:
Justin Giese
TELEPHONE:
(951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE:
10/25/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
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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:
DAVIS FAMILY CHILD CARE
FACILITY NUMBER:
364804137
VISIT DATE:
10/25/2022
NARRATIVE
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• 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 LPA during this inspection.
Tested by LPA at 12:15pm
•
At 12:30pm LPA observed detergents and cleaning compounds in the faculty's laundry room.
Laundry room is covered by a curtain. Accessibility to this area cannot be secured or locked. Licensee removed items and placed them in the locked garage at time of visit.
See LIC809D for type A deficiency cited
•
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.
•
At 12:00pm upon entry of the facility, LPA observed the facility stairs were not properly barricaded
for the age of children currently in care.
See LIC809D for type A deficiency cited
• Fireplace is properly barricaded
• Home has heating and ventilation for safety and comfort
• Safe and appropriate toys and equipment are present for both indoor and outdoor activities
• At 12:39 LPA toured the outdoor play areas. LPA observed broken furniture, wood and other items on the side yard of the facility. The side yard has a fence with a missing gate which makes this area accessible to children.
See LIC809D for type B citation
• 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
08/2024
• Health & Safety Certificate - completed and on file
SUPERVISOR'S NAME:
Gilbert Sena
TELEPHONE:
(951) 782-4200
LICENSING EVALUATOR NAME:
Justin Giese
TELEPHONE:
(951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE:
10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/25/2022
LIC809
(FAS) - (06/04)
Page:
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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:
DAVIS FAMILY CHILD CARE
FACILITY NUMBER:
364804137
VISIT DATE:
10/25/2022
NARRATIVE
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• There are no bodies of water present. 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. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
·
Documentation of fire drills were not available for review.
See LIC809D for type B deficiency cited.
·
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
10/25/2022.
Reminders:
- Current facility’s phone numbers must be on file at all times.
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty
- Documentation of fire & earthquake drills are to be conducted every six months
- Responsibilities of being a mandated reporter
- Baby walkers, bouncy seats, exersaucers and other similar items are prohibited
- The licensee is urged to visit the U.S. Consumer Product Safety Commission webpage at
www.cpsc.gov
to ensure that equipment purchased for the day care has not been recalled.
- 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
.
- Responsibility to know the regulations for anyone providing care
- Inaccessibility of hazards must be constantly reassessed depending on the children in care.
- Please subscribe to
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
SUPERVISOR'S NAME:
Gilbert Sena
TELEPHONE:
(951) 782-4200
LICENSING EVALUATOR NAME:
Justin Giese
TELEPHONE:
(951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE:
10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/25/2022
LIC809
(FAS) - (06/04)
Page:
3
of
9
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:
DAVIS FAMILY CHILD CARE
FACILITY NUMBER:
364804137
VISIT DATE:
10/25/2022
NARRATIVE
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- The Duty Officer is available to answer questions Monday – Friday 8am-5pm at 951-782-4200
Complaint intake is available at: 1-844-LET-US-NO (1-844-538-8766).
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
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
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. 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
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.
SUPERVISOR'S NAME:
Gilbert Sena
TELEPHONE:
(951) 782-4200
LICENSING EVALUATOR NAME:
Justin Giese
TELEPHONE:
(951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE:
10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/25/2022
LIC809
(FAS) - (06/04)
Page:
4
of
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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:
DAVIS FAMILY CHILD CARE
FACILITY NUMBER:
364804137
VISIT DATE:
10/25/2022
NARRATIVE
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to
inspectionprocess@dss.ca.gov
.
For additional information regarding the inspection and its tools and methods, please visit the
Program website
at
www.cdss.ca.gov/inforesources/community-care-licensing/process
.
Exit interview conducted and report was reviewed with the licensee
Sandra Davis
.
LPA issued a Notice of Site Visit and verified it was posted in a prominent location at the facility. Licensees understands that the Notice of Site Visit must remain posted for the next 30 days along with a copy of all Type A deficiencies cited during this inspection. A copy of all Type A deficiencies cited during this inspection must also be immediately (within 24 hours of 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). Licensees are required to have all parents sign and date the Acknowledgement of Receipt of Licensing Reports (LIC9224) and maintain a copy in each child’s file. A copy of this report, LIC9224 and Appeal Rights (LIC9058) were provided during this inspection.
SUPERVISOR'S NAME:
Gilbert Sena
TELEPHONE:
(951) 782-4200
LICENSING EVALUATOR NAME:
Justin Giese
TELEPHONE:
(951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE:
10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/25/2022
LIC809
(FAS) - (06/04)
Page:
5
of
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Document Has Been Signed on
10/25/2022 03:44 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
CCLD Regional Office
,
3737 MAIN ST., SUITE 700
RIVERSIDE
,
CA
92501
FACILITY NAME:
DAVIS FAMILY CHILD CARE
FACILITY NUMBER:
364804137
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
10/25/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(b)
Operation of A Family Child Care Home
(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA's observation and interviews, LPA observed dirty walls, dirty floors, clutter obstructing use of on-limts arears of the facility, overflowing garbage in the kitchen and remnants of food on the kitchen floor and countertops. This is an immediate health and safety risk to children in care.
the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
10/26/2022
Plan of Correction
1
2
3
4
Licensee acknowledges the facility has fallen into disrepair and understands the facility needs to be clean and orderly at all times. Licensee will immediately deep clean the facility and remove and/or organized clutter in on and off limits areas on or before the stated plan of correction date listed. LPA will return to the facility at a later date to physically inspect its condition.
Type A
Section Cited
CCR
102417(g)(3)
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: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, the licensee did not comply with the section cited above. Upon entry to the facility LPA observed the facility's stairs not propperly barricaded for the ages of the children in care. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
10/26/2022
Plan of Correction
1
2
3
4
Licensee barricaded the stairs with a baby gate/fence during inspection. POC cleared at time of visit.
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:
Gilbert Sena
TELEPHONE:
(951) 782-4200
LICENSING EVALUATOR NAME:
Justin Giese
TELEPHONE:
(951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE:
10/25/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/25/2022
LIC809
(FAS) - (06/04)
Page:
6
of
9
Document Has Been Signed on
10/25/2022 03:44 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
CCLD Regional Office
,
3737 MAIN ST., SUITE 700
RIVERSIDE
,
CA
92501
FACILITY NAME:
DAVIS FAMILY CHILD CARE
FACILITY NUMBER:
364804137
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
10/25/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above. LPA observed laundry detergent and cleaning agents in the faciilty laundry area. Laundry area is covered with a curtain and cannont be locked and secured, this poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
10/26/2022
Plan of Correction
1
2
3
4
Licensee removed all detergent and cleaning compounds and moved them to the garage area. POC cleared at time of visit.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
Gilbert Sena
TELEPHONE:
(951) 782-4200
LICENSING EVALUATOR NAME:
Justin Giese
TELEPHONE:
(951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE:
10/25/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/25/2022
LIC809
(FAS) - (06/04)
Page:
7
of
9
Document Has Been Signed on
10/25/2022 03:44 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
CCLD Regional Office
,
3737 MAIN ST., SUITE 700
RIVERSIDE
,
CA
92501
FACILITY NAME:
DAVIS FAMILY CHILD CARE
FACILITY NUMBER:
364804137
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
10/25/2022
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
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above. Current fire drill log was not available for review at time of visit, this poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/01/2022
Plan of Correction
1
2
3
4
Licensee understands the importance of this regulation and will conduct and log a fire drill and provide proof to LPA on or before the stated POC date of 11/01/2022.
Type B
Section Cited
CCR
102417(g)(6)
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: (6) Outdoor play areas shall be either fenced, or outdoor play areas shall be supervised by the licensee Section 102417(g)(5).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, the licensee did not comply with the section cited above. LPA observed fenced side yard was missing the gate which provides access. LPA observed broken furniture, wood and other items which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/01/2022
Plan of Correction
1
2
3
4
Licensee moved a section of fencing blocking access to side yard. POC cleared at time of visit.
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:
Gilbert Sena
TELEPHONE:
(951) 782-4200
LICENSING EVALUATOR NAME:
Justin Giese
TELEPHONE:
(951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE:
10/25/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/25/2022
LIC809
(FAS) - (06/04)
Page:
8
of
9
Document Has Been Signed on
10/25/2022 03:44 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
CCLD Regional Office
,
3737 MAIN ST., SUITE 700
RIVERSIDE
,
CA
92501
FACILITY NAME:
DAVIS FAMILY CHILD CARE
FACILITY NUMBER:
364804137
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
10/25/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(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.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, record review, the licensee did not comply with the section cited above. Licensee did not have immunization records on file for their assistant, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/08/2022
Plan of Correction
1
2
3
4
Licensee understands the importance of this regulation and provide LPA with assistant's immunizations for MMR and Tdap on or before the stated POC date of 11/08/2022.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
Gilbert Sena
TELEPHONE:
(951) 782-4200
LICENSING EVALUATOR NAME:
Justin Giese
TELEPHONE:
(951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE:
10/25/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/25/2022
LIC809
(FAS) - (06/04)
Page:
9
of
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