334845571-9-28-2023-09-CC-TBEN-CU2VU5-20230724164411

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334845571
Report Date: 07/24/2023
Date Signed: 09/28/2023 08:28:00 AM

Document Has Been Signed on 09/28/2023 08:28 AM - 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:	ROBINSON BUCKNER FAMILY CHILD CARE		FACILITY NUMBER:	334845571
ADMINISTRATOR:	ROBINSON BUCKNER,JACQUELYN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	9513336261
CITY:	BANNING	STATE: CA	ZIP CODE:	92220
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 18	CENSUS: 13	DATE:	07/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:14 PM
MET WITH:	Jacquelyn Robinson-Buckner		TIME COMPLETED:	04:53 PM

NARRATIVE

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On date and time listed, Licensing Program Analyst (LPA) Taityana Benson and Licensing Program Manager Aaron Ross arrived at the facility to conduct a required/annual inspection as part of a compliance review. LPA/LPM toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed. Normal days and hours of operation are: SUNDAY - SATURDAY, 6:00AM - 11:59 PM
OFF-LIMIT AREAS INCLUDE: MASTER BEDROOM & BATH, AND GARAGE. The facility is operating within the licensed capacity and appropriate ratios

· Appropriate supervision provided during this inspection

· A working telephone is present and current number on file

· Appropriate fire extinguisher, smoke detector and carbon monoxide detector present and were tested by the Licensee during this inspection.

· Fireplace is properly screened to prevent access by children

· All hazardous items are stored inaccessible to children

· Toxins are locked

· Weapons are not present. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations

· Verification of control of property on file

· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted

· Mandated Reporter Training completed on 06/23/2021

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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: ROBINSON BUCKNER FAMILY CHILD CARE	FACILITY NUMBER: 334845571
	VISIT DATE: 07/24/2023

NARRATIVE

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·Pediatric CPR and First Aid Card expire on 07/2025

· Health & Safety Certificate - completed on 09/2016

· No bodies of water at this time.

· Clean, safe and age appropriate toys

· Current roster on file

· Documentation of fire and disaster drills on file – Last drill conducted on 12/28/2022

· Children’s records are not complete

· Employee’s records are not complete

· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov

· Resident and/or staff records reviewed on 07/24/2023 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.

· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

- 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.

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)/ (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

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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: ROBINSON BUCKNER FAMILY CHILD CARE	FACILITY NUMBER: 334845571
	VISIT DATE: 07/24/2023

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- Licensee 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.

- 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 Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200

See LIC809-D for cited deficiencies.

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.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

The Licensee, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

Exit interview conducted and report was reviewed with the licensee, Jacquelyn Robinson-Buckner.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/28/2023 08:28 AM - It Cannot Be Edited

Created By: Taityana Benson On 07/24/2023 at 03:45 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: ROBINSON BUCKNER FAMILY CHILD CARE	FACILITY NUMBER: 334845571
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that Immunization (MMR and Influzena) missing for Staff Member #2, which poses a potential health & safety risk to persons in care.
	POC Due Date: 08/14/2023
	Plan of Correction
1 2 3 4	Licensee agrees to obtain and submit proof of Staff Member #2 Immunization (MMR and Influenza) to the department by 08/14/2023.

Type B

Section Cited

HSC

1596.8662(b)(1)

This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Provder and Employees should complete Mandated Reporter Training every two years following the date he/she completed their initial training. Based on record review, Licensee and Staff Member #2 Mandated Reporter Training expired. There is no documented on Mandated Reporting for Staff Member #3
	POC Due Date: 07/31/2023
	Plan of Correction
1 2 3 4	Licensee agrees to complete and submit proof of Mandated Reporter Training to the department for all staff by 07/31/2023.

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:

Taityana Benson

LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

LIC809 (FAS) - (06/04)

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