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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845095
Report Date: 06/28/2023
Date Signed: 06/28/2023 04:14:49 PM


Document Has Been Signed on 06/28/2023 04:14 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:GREEN FAMILY CHILD CAREFACILITY NUMBER:
364845095
ADMINISTRATOR:BRENDA GREENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 587-6270
CITY:ONTARIOSTATE: CAZIP CODE:
91764
CAPACITY:14CENSUS: 8DATE:
06/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Brenda GreenTIME COMPLETED:
04:30 PM
NARRATIVE
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On date and time listed, Licensing Program Analyst (LPA) Aman Sharma arrived at the facility to conduct a required annual inspection. LPA toured the indoor area of the facility. No outdoor area is available to the children, due to HOA restrictions. The following was observed and/or discussed:
Normal days and hours of operation are: 7 days a week, Monday-Monday, 12am-11pm.

OFF-LIMIT AREAS ARE LISTED AS FOLLOWS: Closet across the on-limit restroom on the first floor, and entire second floor.

· The facility is operating within the licensed capacity and appropriate ratios


· Appropriate supervision was being provided during this inspection

· A working telephone is present and current phone number is on file

· Appropriate fire extinguisher, smoke detector and carbon monoxide detector were all in working.

· The fireplace is screened off and not accessible by children.

· All hazardous items and toxins were not kept in an off-limit area of the home and were accessible to daycare children-SEE LIC809D

· No weapons are present in the home at this time. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations.

· Stairs are properly barricaded to prevent access to children in care.

· All required postings are posted in a prominent location of the home.

· Mandated Reporter Training for licensee has not been completed since they were licensed in 2019. Licensee stated they were unaware that this needed to be re-done every 2 years.- SEE LIC809D

SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2023
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 364845095
VISIT DATE: 06/28/2023
NARRATIVE
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·Pediatric CPR and First Aid Card for licensee has not been renewed since licensure in 2019. Licensee stated they were unaware that this needed to be re-done every 2 years. -SEE LIC809D.

· Health & Safety Certificate is completed and on file.

· No bodies of water on property at this time. 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. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.

· Clean, safe and age appropriate toys were available to the daycare children.

· Roster is current and on file.

· Documentation of fire and disaster drills are also on file – Last drill conducted on: 05/05/2023

· 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

· Children’s records were incomplete - SEE LIC809D

· Licensee’s file was reviewed and was missing documentation-SEE LIC809D

· Resident and/or staff records reviewed indicate that all adults who require caregiver background checks have received all required clearances or exemptions-SEE LIC809D.

· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations862@dss.ca.gov

- LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage as an additional resource at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep

LPA also advised licensee to look up the Safe Sleep PIN and review all the regulations that came out in 2020 for safe sleep. Licensee was provided with LIC9227.

SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 364845095
VISIT DATE: 06/28/2023
NARRATIVE
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-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.

-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

- 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.

- Licensee was advised to go on the webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the Quick Links. Licensee can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.


- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200

The Licensee, Brenda Green confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

-LPA Sharma informed licensee, Brenda Green that this report dated 06/28/23 document(s) (2) Type A citations, which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Additionally, LPA Sharma informed the licensee to provide a copy of this licensing report dated 06/28/23 that documents any Type A citation(s) 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. Exit interview conducted and report was reviewed with the licensee, Brenda Green. A notice of site visit was given and must remain posted for 30 days

SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 06/28/2023 04:14 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: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 364845095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2023

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
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Based on observation, the licensee did not comply with the section cited above. The on-limits restroom had air freshener, toothpaste tubes, shampoo and oral rinse found under the sink and in the bathroom drawers. The kitchen fridge had chemicals like raid, Lysol disinfectant and cleaning solutions on the top of it, accessible to the older, taller children. There was also an exposed pipe in the kitchen ceiling. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/29/2023
Plan of Correction
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Licensee removed all items in the restroom and above the kitchen fridge immediately and put them all in an off-limit area of the home. Licensee agrees to put something up temporarily on top of the exposed pipe in the kitchen. Licensee will submit to licensing by POC due date.
Type A
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. 2 infants in care did not have 15 minute checks on file. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/29/2023
Plan of Correction
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Licensee agrees to submit proof of implementing 15 minute checks for all infants by POC due date. Infants are up to 24 months of age for licensing.
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 WilliamsTELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6


Document Has Been Signed on 06/28/2023 04:14 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: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 364845095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and licensee's own admission, the licensee was unaware that mandated reporter training had to be completed every 2 years. There was no mandated reporter training presented to LPA during today's inspection. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2023
Plan of Correction
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Licensee agrees to submit proof of mandated reporter training for "Child Care Providers" to licensing no later than POC due date.
Type B
Section Cited
CCR
102370(d)(3)
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: (3) Request and be approved for a transfer of a criminal record exemption, as specified in Section 102370.1(p), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. LIcensee's assistant had their criminal background clearance completed, but licensee did not ensure they were associated to the facility roster. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/29/2023
Plan of Correction
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Licensee agrees to respond to the "Action Required" letter and submit proof to licensing no later than POC 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 WilliamsTELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 06/28/2023 04:14 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: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 364845095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(6)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (6) Documentation of completion of training on preventative health practices as required by Section 102416(c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and licensees own admission, the licensee did not comply with the section cited above. Licensee was unaware that she needed to get her CPR/First Aid card renewed every 2 years. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/12/2023
Plan of Correction
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Licensee agrees to submit proof of enrollment to licensing no later than POC due date. Licensee agrees to follow this up with proof of certificate to licensing.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Kimberly WilliamsTELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2023
LIC809 (FAS) - (06/04)
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