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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842493
Report Date: 06/02/2022
Date Signed: 06/02/2022 03:44:27 PM


Document Has Been Signed on 06/02/2022 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:FOSTER FAMILY CHILD CAREFACILITY NUMBER:
364842493
ADMINISTRATOR:FOSTER, LOLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 616-2431
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY:14CENSUS: 9DATE:
06/02/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Lola FosterTIME COMPLETED:
04:00 PM
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On 06/02/2022 Licensing Program Analyst (LPA) Justin Giese made an unannounced plan of corrections visit for citations issued during an unannounced visit to the facility on 05/18/2022. LPA met with Licensee, Lola Foster and discussed the purpose of the visit.

Licensee was previously cited on 05/18/2022 for failing to provide LPA with a complete file for Staff 1. in addition, Licensee needs to re-new certifications and maintain a complete file of their own documentation. LPA has been in contact with Licensee via unannounced visits conducted on 05/18/2022, 05/24/2022 and this day. Licensee has been provided documentation, checklists and other resources to clear the citation issued for failing to maintain staff files.

The following outstanding corrections pertaining to staff files were not completed at time of visit. Licensee is actively working towards fulfilling this requirement and will need to complete the following before the citation will be cleared:

Documents needed:
Immunizations - Tdap, MMR (Licensee, Staff 1)
Current CPR card (Licensee, Staff 1)
Current Mandated Reporter Certification (Licensee, Staff 1)
EMSA Preventative Health and Safety Training certification (Licensee)

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

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: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2022
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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