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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845483
Report Date: 04/05/2024
Date Signed: 04/05/2024 12:06:01 PM

Document Has Been Signed on 04/05/2024 12:06 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:JORDAN FAMILY CHILD CAREFACILITY NUMBER:
334845483
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
04/05/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH:Olivia Jordan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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On 04/05/2024 at 8:10 AM, Licensing Program Analyst (LPA) Susan Brewer arrived at the facility unannounced to conduct an Annual Inspection. In addition, the licensee has applied to increase her capacity to that of a Large Family Child Care Home. Present during this visit were the licensee and 1 adult staff. LPA toured the facility, inside and out, records were reviewed, and the following was observed: A fire clearance was granted and received on 03/11/2024 for large capacity of 12-14 children, however the Garage is not approved for use. The outdoor activity area is temporarily Off – Limits due to construction and landscaping. The licensee was informed that a Case Management Inspection may be required to re-open the outdoor activity area once the construction is complete. The licensee left the facility at 8:50 AM for a scheduled appointment and a staff member remained at the facility to supervise children in their absence and assist with the inspection. Licensee returned to the inspection at 10:00 AM to resume the inspection.

Normal days and hours of operation: Mon-Fri, 7:00 AM to 4:30 PM
OFF-LIMIT AREAS INCLUDE: The Garage, Master Bedroom & Bath, Bedrooms 1, 2, 3 & 4, Bathroom #2 and the Laundry Room; All Outdoor Play areas are Temporarily Off – Limits.

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. LPA took a census of 3 children in care.
· A fully charged fire extinguisher (2A:10BC) was observed, smoke detector and carbon monoxide detector are present and were tested by the licensee during this inspection on 04/05/2024.
· All hazardous items inaccessible and locked under the sink and in the garage.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2024
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: JORDAN FAMILY CHILD CARE
FACILITY NUMBER: 334845483
VISIT DATE: 04/05/2024
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· Toxins locked under the sink and in the garage.
· No guns or weapons present on 04/05/2024. LICENSEE OLIVIA JORDAN UNDERSTANDS ALL GUNS, WEAPONS AND AMMUNITION MUST BE KEY-LOCKED SEPARATELY AND MADE INACCESSIBLE PER TITLE 22 REGULATIONS.
· This is a 1 story/level home and no stairs observed in the home.
· The fireplace is properly screened on 04/05/2024.
· Verification of control of property on file by rental agreement.
· Property owner/landlord notification and consent on file and verified on 02/26/2024.
· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights forms are posted.
· Pediatric CPR and First Aid Card - expire on 03/2026.
· Health & Safety Certificate - completed on 08/12/2020.
· Mandated Reporter General: 03/01/2019; AB1207 expired: 03/2024
· There are no bodies of water as of this 04/05/2024. 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.
· There are no toxic plants observed at this time.
· Current roster on file and verified on 04/04/2024.
· Documentation of fire drills on file. Last fire drill took place on 02/12/2024 at 2:52 PM with 4 children present.
· Children’s records are complete on 04/04/2024.
· Employee’s records are NOT complete on 04/05/2024. Staff did not have proof of AB107 Mandated Reporter Training expired 03/2024, Proof of renewal not on file.
· Criminal record clearances are required prior to all adults living or working in a Family Child Care Home. A civil penalty of $100.00 per day the person has been present, may be assessed.
Resident and/or staff records reviewed on 04/05/2024 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: JORDAN FAMILY CHILD CARE
FACILITY NUMBER: 334845483
VISIT DATE: 04/05/2024
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The Licensee/Applicant Olivia Jordan, was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
Issued applicant the following: SIDS information and Shaken Baby Syndrome pamphlet.

Incidental Medical Services (IMS) policy was discussed due to the licensee Olivia Jordan notifying the LPA of their request to provide IMS for a newly enrolled child. 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

LPA Susan Brewer, discussed the safe sleep regulations with Licensee/Applicant Olivia Jordan 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 Applicant 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.

Licensee/Applicant Olivia Jordan was reminded that 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, 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.

As a REMINDER: when your child(ren) turn 18 years of age, you MUST SUBMIT an updated LIC279 and TB Screen and have your child submit for LIVESCAN background clearance.

LPA reviewed with Applicant 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. Entrance Checklist was provided to the applicant.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: JORDAN FAMILY CHILD CARE
FACILITY NUMBER: 334845483
VISIT DATE: 04/05/2024
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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.

Additionally, The following was discussed with the applicant(s):
- AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – Requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years.
- Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov

- Pre-Licensing Visit Packet reviewed.
- 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: renew every 2 years.
- Access to forms & Regulations for Family Child Care online at www.ccld.ca.gov
- Responsibility to know the regulations for anyone providing care
- Inaccessibility of hazards must be constantly re-assessed depending on the children in care
- Current facility’s phone numbers must be on file with the licensing office at all times
- Baby walkers, bouncy seats, exer-saucers and other similar items are prohibited

If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also be posted for 30 days.

v The Duty Officer is available to answer questions Mon. – Fri.at 1-844-LET-US-NO (1-844-538-8766).
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: JORDAN FAMILY CHILD CARE
FACILITY NUMBER: 334845483
VISIT DATE: 04/05/2024
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Before licensure, the following needs to be corrected/completed on or before 05/06/2024:
1. Proof of Mandated Reporter Training for the licensee and staff

Once all corrections have been made, with proof sent to licensing, the application for a Large Family Child Care Home will be submitted for approval with a maximum capacity of 12, or 14 with parent notification. As agreed upon by the licensee, all corrections are due within 30 days. If not received within 30 days from the date of this report, the application may be withdrawn and the license will remain a Small Family Child Care Home.

During the exit interview, the licensee Olivia Jordan confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

A deficiency was issued on today’s date for a Type B violation.

No civil penalties issued on today’s date.

Exit interview conducted and report was reviewed with the Licensee/Applicant Olivia Jordan.

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.

The LPA observed the licensee post the Notice of Site Visit for public view, prior to exiting the facility.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/05/2024 12:06 PM - It Cannot Be Edited


Created By: Susan Brewer On 04/05/2024 at 11:51 AM
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: JORDAN FAMILY CHILD CARE
FACILITY NUMBER: 334845483

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
(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 record review, the licensee did not comply with the section cited above in 1 staff present did not renew the required mandated reporter training after 03/2024 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/06/2024
Plan of Correction
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The licensee agrees to ensure and submit proof of mandated reporter training for all employees 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.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Kimberly Williams
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2024


LIC809 (FAS) - (06/04)
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