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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334820406
Report Date: 03/18/2024
Date Signed: 03/18/2024 03:15:49 PM

Document Has Been Signed on 03/18/2024 03:15 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:DOBSON FAMILY CHILD CAREFACILITY NUMBER:
334820406
ADMINISTRATOR:DOBSON, TAMARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 340-3186
CITY:MIRA LOMASTATE: CAZIP CODE:
91752
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
03/18/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:29 AM
MET WITH:Tiffany Dobson Johnson, StaffTIME COMPLETED:
03:25 PM
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On 03/18/2023 at 8:29 AM Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to conduct an annual inspection. LPA was greeted by Facility Staff Tiffany Johnson and granted entry to tour the facility inside and out. LPA reviewed records and observed and/or discussed the following: The licensee Tamara Dobson, was away from the facility at the time of the inspection. Present were 2 licensee staff and 1 volunteer, supervising 9 children. At 10:30 AM, the licensee Tamara Dobson and spouse Kevin Dobson, arrived at the facility, however the inspection and tour continued with Staff Tiffany Johnson.

The licensee has changed the days and hours of operation as indicated below and the licensee has a separate insurance policy for the daycare. The licensee agrees to update the discussed changes on the LIC279 Application form, the LIC999A Facility Sketches for the Home and Yard. The licensee also agrees to submit an updated Incidental Medical Plan, to the department. The licensee was informed that a case management inspection may be required to inspect the outdoor activity area, for repairs to the pool fencing. The licensee agrees to place the outdoor activity area temporarily off-limits, until the repairs are completed.

Normal days and hours of operation are Monday- Friday, 7:30 AM to 5:15 PM.
OFF-LIMIT AREAS INCLUDE: Entire 2nd Floor, downstairs laundry room, small storage space of garage, formal living room, family room, kitchen and dining area; The entire outdoor activity area is temporarily off-limits pending repair to pool fencing.

The inspection consisted of reviews of the following domain: Physical Plant, Care and Supervision, Records, Facility Administration, Staffing Ratio and Capacity, Personal Rights. The inspection found the facility to be in compliance in these domains, except as noted on the LIC809D. The facility is operating within the licensed capacity and appropriate ratios with a census of 9 children in care.
· The Licensee is present in the home and has ensured that children in care are supervised.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2024
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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: DOBSON FAMILY CHILD CARE
FACILITY NUMBER: 334820406
VISIT DATE: 03/18/2024
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· When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children.
· A working telephone is present.
· LPA observed 2 fully charged fire extinguishers with the needles in the green, however the extinguishers observed were not the required 2A:10BC. A smoke detector and carbon monoxide detector were present and tested by the licensee during this inspection and are working.
· All hazardous items are inaccessible, this includes detergents, cleaning compounds, medications and other items which could pose a danger to children.
· Storage of poisons are inaccessible to children were locked.
· A fireplace in the home is covered.
· No guns or weapons present as stated by the Licensee. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations.
· Stairs are NOT barricaded on 03/18/2024, located across the hallway where daycare children access the restroom. No children were observed next to the stairs at the time of the inspection.
· Home is clean and orderly, with heating and ventilation for safety and comfort.
· Clean, Safe and age-appropriate toys and equipment are present for both indoor and outdoor activities.
· Outdoor play areas are fenced and/ or appropriate supervision is present.
· Verification of control of property on file by deed of trust 02/27/2007.
· Pediatric CPR and First Aid Card expires on 11/2025.
· Health & Safety Certificate - completed on 08/26/2016.
· Mandated Reporter General: NOT ON FILE; AB 1207 Child Care Expires: NOT ON FILE
· Fire clearance: 06/26/2008.
· Documentation of fire & earthquake drills to be conducted every six months: Last drill on 02/13/2024, with 10 children present.
· There ARE bodies of water, 03/18/2024. The licensee Tamara Dobson, 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.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
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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: DOBSON FAMILY CHILD CARE
FACILITY NUMBER: 334820406
VISIT DATE: 03/18/2024
NARRATIVE
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In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position. The licensee’s staff Tiffany Johnson and spouse Kevin Dobson, accompanied LPA Susan Brewer, while inspecting the outdoor pool fencing, which is made of mesh panels with metal posts. During the inspection the LPA observed a fence post on the west end of the outdoor area to be detached from the wooden fence and unsecured, a panel to be leaning inward and the entry panel/gate does not self latch.
· Children’s files are NOT complete: 2 of 9 children present were missing files, 8 of 9 children missing the LIC627 Medical Consent forms, 2 children missing immunization records, 1 child missing LIC9227 & sleep logs, 4 children missing LIC995A Parent’s Rights form.
· Staff’s files are NOT complete: 3 staff present and caring for children do not have required personnel records, immunization records or mandated reporter training records available for review.
· A review of staff records on 03/18/2024 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

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.

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 staff Tiffany Johnson, 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.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
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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: DOBSON FAMILY CHILD CARE
FACILITY NUMBER: 334820406
VISIT DATE: 03/18/2024
NARRATIVE
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LPA Susan Brewer, discussed the safe sleep regulations with staff Tiffany Johnson, 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 Staff Tiffany Johnson, 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.

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/process.

Deficiencies were issued on today’s date for a Type B violations.

No civil penalties issued on today’s date.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Staff Tiffany Johnson.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/18/2024 03:15 PM - It Cannot Be Edited


Created By: Susan Brewer On 03/18/2024 at 01:45 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: DOBSON FAMILY CHILD CARE
FACILITY NUMBER: 334820406

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(5)(A)
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: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence. (A)Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view. The bottom and sides of the fence shall comply with Division 1, Appendix Chapter 4 of the 1994 Uniform Building Code. In addition to meeting all of the aforementioned requirements for fences, gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate. Pool covers shall be strong enough to completely support the weight of an adult and shall be placed on the pool and locked while the pool is not in use.

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 in LPA observed the pool fencing post on the west end of the outdoor area to be detached and unsecured, a section of the mesh panel to be leaning inward and the entry panel/gate does not self-latch to close shut which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/18/2024
Plan of Correction
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The licensee agrees to notify the department of repairs to the fence surrounding the outdoor pool and submit proof of repairs on or before 04/18/2024.

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:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/18/2024 03:15 PM - It Cannot Be Edited


Created By: Susan Brewer On 03/18/2024 at 01:45 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: DOBSON FAMILY CHILD CARE
FACILITY NUMBER: 334820406

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

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 in the facility was unable to provide proof of 15 minute log for an infant under 2 years of age, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/20/2024
Plan of Correction
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The licensee agrees to submit proof of 15 minute log for a subject infant child enrolled at the facility, and submit proof of log to the department by close of business day on or before 03/20/2024.
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 interview and record review, the licensee did not comply with the section cited above in the licensee and staff member did not have proof of the required mandated reporter training, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/18/2024
Plan of Correction
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The licensee agrees to submit proof of completed mandated reporter training, 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. Proof of traning will be submitted by fax, mail or e-mail to the department on or before 04/18/2024.
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:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2024


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Document Has Been Signed on 03/18/2024 03:15 PM - It Cannot Be Edited


Created By: Susan Brewer On 03/18/2024 at 01:45 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: DOBSON FAMILY CHILD CARE
FACILITY NUMBER: 334820406

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(j)
Admission Procedures and Authorized Representatives Rights
(j) Copies of the signed receipt shall be available to the Department as provided in Section 102391(d).

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 in 4 of 9 children present and in care did not have the lIC995A Parent's Rights forms on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/25/2024
Plan of Correction
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The licensee agrees to submitt proof of LIC995A Parent's Rights forms to the deparment on or before 03/25/2024.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

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 staff present and caring for childen did not have proof of immunization records for measles, pertussis and influenza or letter to decline the influenza. In addition, the staff do not have proof of screening for Tuberculosis, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/25/2024
Plan of Correction
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The licensee agrees to ensure that a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year; and submit proof of required immunization records for personnel and volunteers on or before 03/25/2024 by fax, mail or e-mail.
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:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2024


LIC809 (FAS) - (06/04)
Page: 7 of 10
Document Has Been Signed on 03/18/2024 03:15 PM - It Cannot Be Edited


Created By: Susan Brewer On 03/18/2024 at 01:45 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: DOBSON FAMILY CHILD CARE
FACILITY NUMBER: 334820406

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
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2
3
4
Based on record review, the licensee did not comply with the section cited above in 2 of 9 children were missing the required LIC700 Identificaiton and Emergency cards and all 8 of 9 children present were missing the LIC627 Medical Consent forms which pose a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/20/2024
Plan of Correction
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The licensee agrees to submit proof of the LIC700 Identification and Emergency Cards and LIC627 Medical Consent forms to the department on or before 03/20/2024 or the next day the child is in care, by fax, mail or e-mail.
Type B
Section Cited
CCR
102418(a)

102418 Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above in 2 children present and in care, did not have proof of immunization records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/20/2024
Plan of Correction
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2
3
4
The licensee agrees to submit proof of required immunization records for 4 children enrolled in daycare on or before 03/20/2024 or the next day the child is in care, by fax, mail or email.
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:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2024


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