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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845360
Report Date: 02/28/2024
Date Signed: 02/28/2024 12:00:48 PM

Document Has Been Signed on 02/28/2024 12:00 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MUSTAFFA FAMILY CHILD CAREFACILITY NUMBER:
334845360
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
02/28/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kathi-Jo MustaffaTIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Tricia Danielson conducted a case management inspection for an increase of capacity, requested by Licensee Kathi-Jo Mustaffa. The licensee has applied to increase the capacity from a Small to a Large Family Child Care Home. A fire clearance was granted for an increase of capacity on 1/9/24. LPA met with Licensee Kathi-Jo Mustaffa and conducted a tour the facility, inside and out, and the following was observed:
· Off-limit areas include: All bedrooms, garage, and both side yards. Off-limit areas are inaccessible to children.
· Normal hours of operation will be Monday - Friday, 5:30 AM - 5:30 PM.
· Smoke and carbon monoxide detectors were in working order.
· There is central heating and air conditioning.
· The fire extinguisher is fully charged and meets standards established by the state fire marshal.
· All hazardous items were observed to be inaccessible. Storage of poisons and toxins are inaccessible to children and locked in the garage. Sharp items including kitchen knives are inaccessible and stored in the kitchen pantry.
· First Aid Kit is located in the entryway closet and contains all required items.
· No guns or weapons are stored in the facility as of this date. Licensee understand all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations.
· There are no stairs at this home.
· The fireplace is properly screened.
· Clean, safe, and age-appropriate toys were observed.
· LPA observed a working telephone.
· There were no toxic plants inside or outside the facility observed at this time.
· The outside activity area consists of covered patio and fenced backyard.
· There are no bodies of water observed on this date. Licensee understand all bodies of water including ponds, above ground pools and spas, in-ground pools and spas, and some fountains must be properly
(CONTINUED ON LIC809-C)
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2024
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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MUSTAFFA FAMILY CHILD CARE
FACILITY NUMBER: 334845360
VISIT DATE: 02/28/2024
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(CONTINUED FROM LIC809)
covered or fenced per title 22 regulations. The Department must be notified before and after installation of the bodies of water described. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position when not in use.
· Verification of control of property is maintained by licensee.
· Facility Sketch and Emergency Disaster Plan are posted in the office.
· Pediatric CPR and First Aid Card expires December 2025.
· Mandated Reporter certificate expires 4/8/2024.
· Preventive Health and Safety training, including nutrition and lead components were completed on 10/27/2018.
Licensee Mustaffa was reminded all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

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) or (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.
LPA reviewed with licensee the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.
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. (CONTINUED ON LIC809-C)
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MUSTAFFA FAMILY CHILD CARE
FACILITY NUMBER: 334845360
VISIT DATE: 02/28/2024
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(CONTINUED FROM LIC809-C)
On today's date, February 28, 2024, The California Attorney General – Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California’s Megan’s Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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 following items were also reviewed with the applicant during inspection:
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.
- Documentation of fire & earthquake drills to be conducted every six months.
- Responsibilities of being a mandated reporter and updating training every two (2) years.
- Personal rights of children in care, including no corporal punishment.
- Responsibility to know the Title 22 Regulations for anyone providing care and supervision.
- Capacity and supervision requirements.
- Inaccessibility of hazards must be constantly reassessed depending on the children in care.
- Current facility phone numbers must always be on file with the licensing office.
- Baby walkers, bouncy seats, exer-saucers, and other similar items are prohibited.
- Car seat law.
- Smoking is prohibited in the facility while providing child care or transporting children.
- The Notice of Site Visit must be posted at the entrance of the facility for a period of
30 days. If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also
be posted for 30 days. A civil penalty of $100 per violation will be assessed for noncompliance.
- Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual
(CONTINUED ON LIC809-C)
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MUSTAFFA FAMILY CHILD CARE
FACILITY NUMBER: 334845360
VISIT DATE: 02/28/2024
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(CONTINUED FROM LIC809-C)
Incident Report email mailbox: UnusualIncidentReportsDO10@dss.ca.gov.
-Licensee can submit fingerprint transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations858@dss.ca.gov.
- Access to forms & Title 22 Regulations for Family Child Care Homes online at www.ccld.ca.gov.
- The Duty Officer is available to answer questions Monday - Friday 8:00 AM to 5:00 PM at: 951-782-4200.

There are no corrections required to meet licensure. The application for a Large Family Child Care Home will be submitted for approval with a maximum capacity of twelve (12) children, no more than four (4) of whom may be infants or up to fourteen (14) children when one child is at least six (6) years of age, and one (1) child is enrolled in and attending kindergarten or elementary school.

An exit interview was conducted, and a copy of this report was reviewed with licensee.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
LIC809 (FAS) - (06/04)
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