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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334830940
Report Date: 07/31/2024
Date Signed: 09/25/2024 11:08:00 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/29/2024 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240729202216
FACILITY NAME:THEDFORD FAMILY CHILD CAREFACILITY NUMBER:
334830940
ADMINISTRATOR:THEDFORD, KEICHELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 377-3671
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY:14CENSUS: 4DATE:
07/31/2024
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Keichel Thedford, LicenseeTIME COMPLETED:
09:50 AM
ALLEGATION(S):
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Licensee does not ensure that daycare child has current vaccinations.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner made an unannounced subsequent complaint visit to the above noted facility to deliver amended findings. LPA met with the Licensee Keichel Thedford and informed them of the purpose of this visit. During this investigation LPA conducted a tour of the facility, conducted an interview with Licensee, and requested and received supportive documentation for review. The following was determined.

It was alleged that the Licensee does not ensure that Child One (C1) has current vaccinations. LPA reviewed the vaccinations for C1 at the facility, and found that C1 was missing one vaccine (M1); however, through other documentation provided by C1's parent (P1), LPA found that the 4th vaccine was administered on 07/29/2024.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 10-CC-20240729202216
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: THEDFORD FAMILY CHILD CARE
FACILITY NUMBER: 334830940
VISIT DATE: 07/31/2024
NARRATIVE
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A review of further documents provided by a medical professional revealed that M1 was delayed being administered to C1 for a valid reason. Due to this, the allegation was found Unsubstantiated.

A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where a copy of this report was reviewed with and provided along with a copy of the LIC811 (confidential names list), and Appeal Rights. A notice of site visit was also provided and must remain posted for 30 days.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 10-CC-20240729202216
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: THEDFORD FAMILY CHILD CARE
FACILITY NUMBER: 334830940
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
08/09/2024
Section Cited
CCR
102418(g)(1)
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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.
(1) This requirement includes updating each child's...child is due to receive required immunizations after enrollment in the family day care home. This requirement was not being met as evidenced by:
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Licensee states that they will coordinate with P1, additionally, Licensee states that they will review the cited regulation and provide proof of such by POC date.
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Based on record review, the Licensee did not ensure that C1's record was maintained. This poses a potential health and safety risk to children in care.
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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.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3