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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846655
Report Date: 10/28/2024
Date Signed: 10/28/2024 12:21:45 PM

Document Has Been Signed on 10/28/2024 12:21 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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:JIN FAMILY CHILD CAREFACILITY NUMBER:
334846655
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/28/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Xinhua Jin, ApplicantTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 10/28/2024 at 8:40 AM, Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to conduct a Pre-licensing inspection. LPA greeted by Applicant Xinhua Jin and granted entry to tour the facility, inside and out. The following was observed and/or discussed: Present during this inspection were the applicant. Interpretation services were declined.

Normal days and hours of operation are Monday - Friday, 7:00 AM to 6:00 PM
OFF-LIMIT AREAS INCLUDE: 1st Floor Bedroom, the Garage, the Entire 2nd Floor and the side yards.

· Appropriate fire extinguisher (2A:10BC), smoke detector are present, are in working order and were tested by the applicant during this inspection, however a carbon monoxide detector is missing.
· The home has a working telephone.
· All hazardous items are NOT inaccessible: The LPA observed Easy off oven cleaner and adult alcoholic beverages unlocked in lower kitchen cabinets.
· No guns or weapons present as of this date. Applicant Xinhua Jin understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations.
· Stairs are NOT barricaded where the LPA observed the first 3 steps of the staircase leading to the 2nd level of the home to be accessible to children.
· The fireplace is properly screened on 10/18/2024.
· Storage of poisons are NOT inaccessible to children and/or locked. The LPA observed vitamin supplements and over the counter medications unlocked in upper kitchen cabinets, toxic cleaning supplies were observed to be unlocked in the kitchen pantry, under the kitchen sink; paint, automotive oil and miscellaneous toxic household supplies were observed unlocked in the garage.
· Verification of control of property is on file as of 10/08/2024 and verified grant deed.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2024
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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: JIN FAMILY CHILD CARE
FACILITY NUMBER: 334846655
VISIT DATE: 10/28/2024
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· Facility Sketch and Emergency Disaster Plan are NOT posted. In addition, the 2nd floor sketch will need to be submitted with updates.
· Pediatric CPR and First Aid Card - expire on 10/21/2025.
· Health, Safety, Nutrition and Lead Certificate completed on 09/11/2024
· Mandated reporter General: 03/21/2024; AB1207 Child Care expires: 03/21/2026
· Fire clearance: THIS APPLICATION IS FOR A SMALL FAMILY CHILD CARE HOME
· Applicant Xinhua Jin, understands all bodies of water including ponds, above ground pools and spas, in-ground pools and 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 when not in use.
· Clean, Safe and age-appropriate toys and equipment are present for both indoor and outdoor activities, however the play yards were observed to have storage inside and attached to the side of the play yards and the restroom designated for daycare children was observed to be unclean. The applicant removed the items inside and attached to the play yards, in the presence of the LPA.
· There are no toxic plants observed at this time and outdoor perimeter is secured with a fence and gates.
· The Applicant Xinhua Jin 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 and a full copy of the Safe Sleep regulations and standards.

Incidental Medical Services (IMS) policy was discussed with the applicant Xinhua Jin. 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: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2024
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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: JIN FAMILY CHILD CARE
FACILITY NUMBER: 334846655
VISIT DATE: 10/28/2024
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LPA Susan Brewer discussed the safe sleep regulations with Applicant Xinhua Jin 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.

Applicant Xinhua Jin 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. The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov for Riverside Regional Office.

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.

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.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2024
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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: JIN FAMILY CHILD CARE
FACILITY NUMBER: 334846655
VISIT DATE: 10/28/2024
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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 provided
- 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 renew training 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 reassessed 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
- Once licensed, 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.
v The Duty Officer is available to answer questions Mon. – Fri.at 1-844-LET-US-NO (1-844-538-8766).

Before licensure, the following needs to be corrected/completed on or before 11/28/2024:
1. LIC610A Emergency Disaster Plan – with updated information.
2. Make poisons, toxins and hazards inaccessible in the garage, kitchen and home, such as the cleaning supplies, adult alcoholic beverages, vitamin supplements, over the counter medications, hazards inaccessible by key or combination lock where stored.
3. Provide proof of a carbon monoxide detector for the home.
4. Make stairs inaccessible to children by properly barricading.
5. Ensure the restroom designated for children is clean.
6. Provide a Second floor sketch (original document).
7. Proof of required postings are up for public view.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2024
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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: JIN FAMILY CHILD CARE
FACILITY NUMBER: 334846655
VISIT DATE: 10/28/2024
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Once all corrections have been verified, the application for a Small Family Child Care Home will be submitted for approval with a maximum capacity of 6, or 8 with parent notification. Applicant advised that all corrections are due within 30 days or the application may be withdrawn. An exit interview was conducted, and a copy of this report was provided to the applicant on this date.

During the exit interview, the Applicant Xinhua Jin 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 Applicant Xinhua Jin.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2024
LIC809 (FAS) - (06/04)
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