334819638-5-16-2023-09-CC-PORS-CRW4DC-20230516190032

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334819638
Report Date: 05/16/2023
Date Signed: 05/16/2023 07:01:06 PM

Document Has Been Signed on 05/16/2023 07:01 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:	FONSECA FAMILY CHILD CARE		FACILITY NUMBER:	334819638
ADMINISTRATOR:	FONSECA, ROSARIO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 315-5712
CITY:	CABAZON	STATE: CA	ZIP CODE:	92230
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 7	DATE:	05/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:11 PM
MET WITH:	Licensee Rosario Fonseca		TIME COMPLETED:	07:10 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 date and time listed, Licensing Program Analyst (LPA) Perla Ordones arrived at the facility to conduct a required/annual inspection as part of a compliance review. LPA toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed: Normal days and hours of operation are: Monday – Sunday; 06:00AM – 05:00AM. OFF-LIMIT AREAS INCLUDE: Garage, Bedroom 1, Bedroom 2, Bedroom 3, Master bedroom. The facility is operating within the licensed capacity but not the appropriate ratios. During visit, LPA observed there to be three infants and four non school age children present at the facility between the times of 02:11PM and 02:54PM. From the times of 02:11PM and 02:54PM, the only adult attending to daycare children was the licensee making her out of ratio. One non school age child left at 02:54PM, putting the licensee back in ratio at that time. · Appropriate supervision was not provided during this inspection. At approximately 02:30PM during LPA's facility tour, LPA observed C1 to be left alone in open door Nursery room and observed C1 to nearly swallow a small toy in the shape of a strawberry. LPA prevented C1 from swallowing toy and asked licensee to retrieve the child upon explaining that C1 almost swallowed the strawberry toy. · A working telephone is present and current number on file. · Appropriate fire extinguisher, smoke detector and carbon monoxide detector present and were tested by the Licensee during this inspection. · A fireplace is not present at the facility. · All hazardous items are stored inaccessible to children. · Toxins are locked.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Perla Ordones
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

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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Document Has Been Signed on 05/16/2023 07:01 PM - It Cannot Be Edited

Created By: Perla Ordones On 05/16/2023 at 06:09 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: FONSECA FAMILY CHILD CARE	FACILITY NUMBER: 334819638
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102417(a)

Operation of A Family Child Care Home

(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as at approximatley 02:30PM, during LPA's facility tour, LPA observed C1 to be left alone in Nursery room and observed C1 to nearly swallow a small toy in the shape of a strawberry which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/17/2023
	Plan of Correction
1 2 3 4	During the visit, after LPA prevented C1 from swallowing the toy, the licensee was asked to retrieve the child and the licensee brought C1 back to the main room with the other children. Licensee agrees to submit a written statement detailing how the Operation of a Family Child Care Home regulation will be followed in the future, especially in regards to supervision. Licensee agrees to submit the Plan of Correction (POC) by the POC due date.

Type A

Section Cited

CCR

102416.5(b)(3)

Staffing Ratio and Capacity

(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (3) More than six and up to eight children, without an additional adult attendant, only if the criteria in Section 1597.44 of the Health and Safety Code are met. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as LPA observed there to be three infants and four non school age children present at the facility between the times of 02:11PM and 02:54PM with the licensee being the only adult attending to daycare children which made the licensee out of ratio. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/17/2023
	Plan of Correction
1 2 3 4	During the visit, one non school age child left at 02:54PM, putting the licensee back in ratio at that time. Licensee agrees to submit a written statement detailing how the Staffing Ratio and Capacity regulation will be followed in the future. Licensee agrees to submit the Plan of Correction (POC) by the 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 Williams

LICENSING EVALUATOR NAME:

Perla Ordones

LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC809 (FAS) - (06/04)

Page: 2 of 11

Document Has Been Signed on 05/16/2023 07:01 PM - It Cannot Be Edited

Created By: Perla Ordones On 05/16/2023 at 06:09 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: FONSECA FAMILY CHILD CARE	FACILITY NUMBER: 334819638
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above as licensee was unable to provide proof of a current valid CPR card which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/06/2023
	Plan of Correction
1 2 3 4	Licensee agrees to submit proof of a valid EMSA approved CPR/First Aid card to Community Care Licensing by the Plan of Correction (POC) date.

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above as C2 was missing proof of all immunizations which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/06/2023
	Plan of Correction
1 2 3 4	Licensee agrees to submit proof of immunizations for C2 to Community Care Licensing by the Plan of Correction (POC) 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

LICENSING EVALUATOR NAME:

Perla Ordones

LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC809 (FAS) - (06/04)

Page: 3 of 11

Document Has Been Signed on 05/16/2023 07:01 PM - It Cannot Be Edited

Created By: Perla Ordones On 05/16/2023 at 06:09 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: FONSECA FAMILY CHILD CARE	FACILITY NUMBER: 334819638
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102419(d)

Admission Procedures and Parental and Authorized Representative's Rights

(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). 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 as C2 was missing proof of the LIC995A which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/06/2023
	Plan of Correction
1 2 3 4	Licensee agrees to submit proof of LIC995A for C2 to Community Care Licensing by the Plan of Correction (POC) date.

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. 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 as C4 was missing proof of the LIC627 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/06/2023
	Plan of Correction
1 2 3 4	Licensee agrees to submit proof of the LIC627 for C4 to Community Care Licensing by the Plan of Correction (POC) 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

LICENSING EVALUATOR NAME:

Perla Ordones

LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC809 (FAS) - (06/04)

Page: 4 of 11

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: FONSECA FAMILY CHILD CARE	FACILITY NUMBER: 334819638
	VISIT DATE: 05/16/2023

NARRATIVE

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· Weapons are not present. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations.
· Facility is a one-story home.
· Verification of control of property was verified.
· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted.
· Mandated Reporter Training completed on 03/03/2022.
· Pediatric CPR and First Aid Card expired on 02/2023. LPA consulted with licensee on the matter and licensee agreed to submit proof of a valid CPR/First Aid to Community Care Licensing.
· Health & Safety Certificate - completed on 06/03/2007.
· No bodies of water 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 are present at the facility. However, upon LPA’s tour of the backyard, LPA noticed that two tricycles in the backyard were seen to be missing the foam/plastic covering on the handle bars. Additionally, the foam/plastic coverings on the seesaw were seen to be in disrepair. LPA did not observe any children to have gone outside during the visit and consulted Licensee on the matter.
· Current roster on file.
· Documentation of fire and disaster drills on file – Last drill conducted on 02/16/2023.
· Children’s records are not complete. During record review, LPA observed some children to be missing the following documents: LIC627, LIC995A, and proof of immunizations. LPA informed licensee on the matter and licensee agreed to retrieve and maintain the appropriate documents in the children’s files.
· Employee’s records are complete except as noted earlier with the Licensee’s CPR/First Aid card.
· 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
· Resident and/or staff records reviewed on 05/15/2023 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.
· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Perla Ordones
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

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

FACILITY NAME: FONSECA FAMILY CHILD CARE	FACILITY NUMBER: 334819638
	VISIT DATE: 05/16/2023

NARRATIVE

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

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 PIN 22-02-CCP. 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at:
https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Perla Ordones
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC809 (FAS) - (06/04)

Page: 10 of 11

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: FONSECA FAMILY CHILD CARE	FACILITY NUMBER: 334819638
	VISIT DATE: 05/16/2023

NARRATIVE

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LPA Perla Ordones informed licensee Rosario Fonseca that this report dated 05/16/2023 document(s) two Type A citation(s) 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.

Also, LPA Perla Ordones informed the licensee Rosario Fonseca to provide a copy of this licensing report dated 05/16/2023 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.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

The LICENSEE, Rosario Fonseca, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

Exit interview conducted and report was reviewed with the licensee Rosario Fonseca.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Perla Ordones
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC809 (FAS) - (06/04)

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