364819798-4-3-2023-09-CC-SBRR-CQJVPH-20230403163645

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364819798
Report Date: 04/03/2023
Date Signed: 04/03/2023 04:36:55 PM

Document Has Been Signed on 04/03/2023 04:36 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	INGRAM FAMILY CHILD CARE		FACILITY NUMBER:	364819798
ADMINISTRATOR:	INGRAM, NICOLE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 422-9938
CITY:	GRAND TERRACE	STATE: CA	ZIP CODE:	92313
CAPACITY:	14	CENSUS: 9	DATE:	04/03/2023
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Licensing Representative Lonita Sweatt & Licensee Nicole Ingram		TIME COMPLETED:	04:45 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 4/03/2023 at 11:15 AM Licensing Program Analysts (LPAs) Susan Brewer, arrived at the facility unannounced for the purpose of clearing a pending Plan of Correction issued on 03/30/2023 during an annual inspection. LPAs were greeted by Licensing Representative Lonita Sweatt - Staff 3 (S3), who stated that licensee was away from the facility and granted LPAs entry into the home. Present were Staff 3, 1 minor assistant and 2 other additional professionals from an outside agency. LPAs took a census of 9 children in care. The licensee arrived at 12:05 PM and took over the inspection. Updated was the LIC279B Current children in the home. During today's visit the following was observed, reviewed and discussed: A criminal record check was conducted on 04/03/2023, with revealed that Staff 3 observed to be present and working with children during the inspection, was NOT associated to work at the facility. Per licensee Nicole Ingram, they were unsure of the exact start date of the employment. The licensee stated that S3 did work at the facility 2 days in March 2023 and on today's date. A written declaration was obtained from the licensee and S3, to confirm. LPAs printed and reviewed a full copy of the regulations listed below with the licensee during the inspection. During today's visit a Informal Meeting with the licensee Nicole Ingram, was scheduled to discuss the Non - Compliance Citations issued on 03/30/2023 for 04/03/2023. The following POCs were cleared for the following deficiencies during this inspection: 1. 102370(d)(1) 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: (1) Obtain a California clearance or a criminal record exemption as required by the Department. LPAs verified that subject Staff 2, was not present at the facility and a statement was provided to the LPAs during the visit. The citation was cleared.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: INGRAM FAMILY CHILD CARE	FACILITY NUMBER: 364819798
	VISIT DATE: 04/03/2023

NARRATIVE

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2. 102416.5(d) Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: LPAs printed and reviewed a full copy of the regulation with the licensee during the inspection. LPAs verified through a census taken of 9 children present during the inspection, that the facility was within the approved ratio and capacity on today's date and a statement was provided to the LPAs during the visit. The citation was cleared.

See LIC809D for cited deficiency this visit 04/03/2023 for 102370(d)(2).

Civil Penalties Issued on 04/03/2023

A Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

LPAs Susan Brewer and Perla Ordones, informed Licensee Nicole Ingram, that this report dated 04/03/2023 documents 1 of Type A citation. Type A citations which shall be posted for 30 consecutive days as there is/are immediate risks to the health, safety, or personal rights of children in care.

Also, LPAs Susan Brewer and Perla Ordones, informed Licensee Nicole Ingram to provide a copy of this licensing report dated 04/03/2023 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

LPA S.Brewer, conducted an exit interview to review the report and a copy was provided to Licensee Nicole Ingram. Appeal rights discussed and a copy of this report was provided to the licensee on this date.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/03/2023 04:36 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: INGRAM FAMILY CHILD CARE	FACILITY NUMBER: 364819798
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/03/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/04/2023 Section Cited	1 2 3 4 5 6 7	102370(d) All individuals subject to a criminal record review pursuant to Health & Safety Code 1596.871 shall prior to working, residing, or volunteering...(2) Request a transfer of a criminal record clearance as specified in Section 102370(j) This regulation was not met as evidenced by:	1 2 3 4 5 6 7	Licensee Nicole Ingram, agrees to submit a LIC9182 Request of a Criminal Record Tranfer for Staff 3 and ensure that the the employee is verified as eligible cleared and associated to the Ingram FCCH, prior to returning to employment at the facility.
	8 9 10 11 12 13 14	Based on LPAs observation, records reviews and declaration for Staff 3 present & the licensee, S3 began working at the daycare 03/27/2023, 03/28/2023, 04/03/2023 & the licensee failed to provide proof of the submitted LIC9182 request to transfer of criminal record clearance, which posed a risk to the health & safety of children in care.	8 9 10 11 12 13 14	Proof of documentation to be cleared will be submitted to the department on or before the close of business day 04/04/2023 by fax, mail or email, along with a statement of understanding the Title 22 regulation requirements for LIC9182 Request of a Criminal Record Tranfers.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Kimberly Williams	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023

LIC809 (FAS) - (06/04)

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