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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842493
Report Date: 05/24/2022
Date Signed: 05/24/2022 02:55:41 PM


Document Has Been Signed on 05/24/2022 02:55 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:FOSTER FAMILY CHILD CAREFACILITY NUMBER:
364842493
ADMINISTRATOR:FOSTER, LOLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 616-2431
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY:14CENSUS: 2DATE:
05/24/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lola FosterTIME COMPLETED:
03:15 PM
NARRATIVE
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On 05/24/2022 at time listed above Licensing Program Analyst (LPA) Justin Giese made an unannounced visit to the facility for the purpose of proof of corrections for deficiencies cited on 05/18/2022 . LPA met with Licensee, Lola Foster and was granted access to the facility.

The following Citations were cleared at time of visit:
1. Criminal Records Clearance
2. Infant safe sleep
3. Posting of License
4. Operation of a Family Child Care Home - The home shall be kept clean and orderly
5. Children's Records

At 10:10am upon entering the facility LPA observed that bedroom 1's door was open and assessable to children in care. LPA observed a tray with green latex paint laying in the corner of the room. Additionally, LPA observed personal hygiene products, labeled keep out of reach from children and insect spray accessible to children in their designated bathroom. Licensee was cited for accessible poisons and toxins on an unannounced visit on 05/18/2022. The facility was found to be in violation of the following Title 22 regulation:

102417(g)(4) Operation of a Family Child Care Home:
(g)(4) Poisons, detergents, cleaning compounds... and other items which could pose a danger... to children shall be stored where they are inaccessible to children. See LIC809D for Type A citation
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin GieseTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2022
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 05/24/2022 02:55 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: FOSTER FAMILY CHILD CARE
FACILITY NUMBER: 364842493

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/25/2022
Section Cited

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Operation of a Family Child Care Home: (g)(4) Poisons, detergents, cleaning compounds... and other items which could pose a danger... to children shall be stored where they are inaccessible to children.


This was not met as evidenced by:
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Based on LPA's direct observations at 10:10am, LPA observed a tray of latex paint in one of the bedrooms as well personal hygiene products and insect spray in the children's on limits bathroom. Licensee failed to make items inaccessible. This is an immediate health and safety risk to children in care.
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Licensee will immedietly remove paint and harmfull substances and properly secure them in a key locked location.

This is a repeat violation. $250 civil penalty will be 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: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin GieseTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3


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: FOSTER FAMILY CHILD CARE
FACILITY NUMBER: 364842493
VISIT DATE: 05/24/2022
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This is a repeat violation that has not been corrected since the last visit.
A Civil Penalty of $250 will be assessed during this investigation for Personnel Records. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”.

The following corrections were not cleared:
1. Personnel Records
2. Personal Rights - To receive safe, healthful, and comfortable accommodations...(Pest Infestation)

At 10:30am Licensee contacted their landlord via telephone. LPA was able to speak to landlord regarding ongoing pest inspection and services provided. LPA obtained a service notice provided by Licensee from a pest exterminator for services rendered on 04/11/2022. LPA was notified the facility will receive additional services to resolve this matter.

Exit interview conducted and report was reviewed with Licensee Lola Foster.

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.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin GieseTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
LIC809 (FAS) - (06/04)
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