364844557-12-13-2021-09-CC-ECOL-C9NT3K-20211213132227

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364844557
Report Date: 12/13/2021
Date Signed: 12/13/2021 01:22:38 PM

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:	GROSS FAMILY CHILD CARE		FACILITY NUMBER:	364844557
ADMINISTRATOR:	GROSS,JEANNETTE & GROSS,KI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 212-5259
CITY:	CHINO	STATE: CA	ZIP CODE:	91710
CAPACITY:	14	CENSUS: 12	DATE:	12/13/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Licensee - Jeannette Gross		TIME COMPLETED:	01:40 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	Licensing Program Analyst (LPA’s) Eileen Corral and Taadhimeka Haynes-Zeigler conducted a required Annual Inspection on today’s date. Prior to entering the Facility LPA Corral reviewed the COVID-19 Prescreening Questionnaire with Licensee Jeannette Gross. Upon entrance to the Facility, there were 12 children present in care with Licensees Jeannette and Kimberly Gross providing care and supervision. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staff to child ratios. A review of the Facility Personnel Report Summary on 12/09/2021 indicates all facility staff who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over, 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 Family Child Care Home. A civil penalty of $100 minimum per day and up to $500 maximum per day per person will be assessed if this regulation is violated. The hours of Operation are Monday – Friday, 6 AM – 6 PM. A tour of the inside and outside of the facility was conducted with Licensee Kimberly Gross. Rooms available to children in care were observed to be equipped with age appropriate furniture. Off limits areas are made inaccessible by means of children safety gates. The childcare primary area is the living room which is located passing the napping room. Equipment was found to be in good condition, free of sharp, loose, or pointed edges. Items which could pose a danger to children such as detergents, cleaning compounds, and medications were observed to be stored out of the reach of children. Licensee stated Poisons/Hazardous items are not kept on the premises. The children's bathroom, toilet and handwashing sink were observed to be clean, sanitary and in good repair. The facility has conducted an emergency drill on 11/10/2021 and maintains documentation of drills. The facility has a working smoke detector, and fire extinguisher. The carbon monoxide detector was found to have low batteries. LPA Corral verified there is a working phone service. Facility meets all posting requirements. Licensee understands the Family Child Care Home shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children. Continue to Page 2.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: 951-233-7183
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 5

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: GROSS FAMILY CHILD CARE	FACILITY NUMBER: 364844557
	VISIT DATE: 12/13/2021

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
26
27
28
29
30
31
32

Page 2.
The outdoor activity areas were also inspected for compliance. The outdoor activity was observed to have age appropriate equipment and to be in good condition. The outdoor area was enclosed by appropriate fence, the play equipment consisted of swings and slides. Licensee was reminded to ensure facility is free of flies, insects and rodents. Licensee was reminded visual supervision is required during outdoor play. There are no bodies of water present on on-site, Licensee was informed all wading pools or similar product must be emptied immediately after use and stored in an upright position. Hazardous items were not observed to be accessible to children in care.

During today’s inspection, LPA Corral and Haynes-Zeigler also conducted Record Review of Staff and Children Files. Each Staff’s files contain the required documentation. Both Licensees' Pediatric CPR/First Aid was completed on 07/20/2021. Mandated Child Abuse Reporter training was completed on 02/13/2021. Review of staff records also contains proof of Staff who are immunized against influenza, pertussis, and measles. Each child’s file contains the required identification and emergency contact information. Both Infant Files were missing the Infant Sleeping Plan LIC 9227 and the Infant Sleeping Log documentation including Infant's Name, Date and time of 15 Minute Check. Licensee was reminded not to exceed the conditions, limitations and capacity specified on the license. Licensee was also informed to ensure each child is accorded a safe, healthful and comfortable accommodations, furnishings and equipment to meet the child's needs.

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 and the Child Care Licensing Safe Sleep webpage was provided https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep. 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.
Continue to Page 3.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: 951-233-7183
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: GROSS FAMILY CHILD CARE	FACILITY NUMBER: 364844557
	VISIT DATE: 12/13/2021

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
26
27
28
29
30
31
32

Page 3.
CCLD website www.ccld.ca.gov was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through childcareadvocatesprogram@dss.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website. A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee.

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/nspection-process

Director was reminded a request to transfer, associate/disassociate individuals can be submitted to Associations_Disassociations862@dss.ca.gov. Director was also informed of their Reporting Requirements, Unusual Incident Reporting inbox was provided UnusualIncidentReportsDO09@dss.ca.gov. Lastly, Director was informed the Duty Officer is available to answer questions Monday – Friday from 8:00am to 5:00pm at (951)782-4200.

Based on Today’s inspection, Facility was found to be out of Compliance of Title 22 California Code of Regulations. See LIC809D for cited deficiencies.

Exit interview was conducted and Evaluation Report was reviewed with Licensee Jeannette Gross. A Notice of Site Visit was provided, Licensee was reminded it must remain posted for 30 days.

End of Report.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: 951-233-7183
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: GROSS FAMILY CHILD CARE	FACILITY NUMBER: 364844557
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/13/2021

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 month of age the provider has in care and maintained at the facility in the infant’s file. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on Infant Record Review, the licensee did not comply with the section cited above in 2 out of 2 Infant Files were missing the Infant Sleeping Plan LIC 9227 which poses a potential health risk to children in care.
	POC Due Date: 12/27/2021
	Plan of Correction
1 2 3 4	Licensee stated she will make copies of the LIC 9227 provided and provide parent's signed copies to department and place in Children's file by due date.

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep (j) The provider shall supervise infants while they are sleeping and adhere to the following requirements: (2) The provider shall check and document the following: (D) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: a. Date. b. Infant’s name. c. Time of each 15-minute check. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on Record Review, the licensee did not comply with the section cited above, 2 out of the 2 Infant Files reviewed did not have a Documentation of an Infant Sleeping Log available for review which poses a potential safety risk to the children in care.
	POC Due Date: 12/20/2021
	Plan of Correction
1 2 3 4	Licensee stated she will create an Infant Sleeping Log for both Infant's in care and add to the Infant's File, completed Sleeping Logs will be provided to department by due date.

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) 248-0228
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: 951-233-7183
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021

LIC809 (FAS) - (06/04)

Page: 4 of 5