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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334842721
Report Date: 01/26/2023
Date Signed: 01/26/2023 01:19:23 PM

Document Has Been Signed on 01/26/2023 01:19 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:RUTHERFORD FAMILY CHILD CAREFACILITY NUMBER:
334842721
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
01/26/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:Mark Rutherford, LicenseeTIME COMPLETED:
01:30 PM
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Licensing Program Analysts (LPAs) Elyse Jones and Karrene Turner arrived at the facility to conduct an inspection for another purpose. During this inspection, census were taken and facility records were reviewed. Present during the inspection was Lexxis Magee, Assistant.

During the tour of the facility LPAs observed two knives and a pair of kitchen scissors on the kitchen counter that were made accessible to the children in care. LPAs had the tallest child in care reach for the knives in front of the Assistant to prove the knives were accessible to children in care.

See LIC809D for deficiency cited per California Code of Regulations Title 22, Division 12 and Health & Safety Code.

An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Licensee.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
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 2
Document Has Been Signed on 01/26/2023 01:19 PM - It Cannot Be Edited


Created By: Elyse Jones On 01/26/2023 at 12:56 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: RUTHERFORD FAMILY CHILD CARE
FACILITY NUMBER: 334842721

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/26/2023
Section Cited
CCR
102417(g)(4)

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Operation of a Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions...(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.
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Assistant removed knives and scissors during the inspection and made them inaccessible to the children in care. Licensee understands that all items that could pose a danger to the children in care must be made inaccessible. Licensee understands all enrolled families must be given an LIC 9224 and all families who enroll within the next 12 months.
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This requirement was not met as evidenced by: Based on the observation, the Licensee did not meet above regulation which poses an immediate Health, Safety & Personal Rights risk to the children in care. During the facility tour LPAs observed two knives and a pair of kitchen scissors on the counter which were accessible to the 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.
SUPERVISOR'S NAME:Aaron Ross
LICENSING EVALUATOR NAME:Elyse Jones
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023


LIC809 (FAS) - (06/04)
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