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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300298
Report Date: 04/14/2022
Date Signed: 04/14/2022 04:23:52 PM

Document Has Been Signed on 04/14/2022 04:23 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:GRAY-ROBINSON FAMILY CHILD CAREFACILITY NUMBER:
336300298
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 7DATE:
04/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Licensee Sasha Gray-RobinsonTIME COMPLETED:
04:30 PM
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On 04/14/2022 at 2:25 PM Licensing Program Analyst (LPA) Susan Brewer and Licensing Program Manger (LPM) Pauline Beschorner arrived at the facility unannounced to conduct an annual inspection. LPA and LPM were greeted by licesnee Sasha Gray-Robinson, conducted a COVID19 prescreening and were granted entry. LPA toured the facility, inside and out, reviewed records, and observed and/or discussed the following: Present is the Licensee, the licensee’s spouse, 7 children in care. Also present was a contract worker actively installing repairs to the facility for water damage reported in Jan 2022.

Normal days and hours of operation will be: Monday through Friday from 6:00 am to 6:30 pm
OFF-LIMIT AREAS INCLUDE: Laundry Room, Garage and Entire 2nd Floor

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 LIC9102TA. Deficiencies not cited this visit.

· The facility is operating within the licensed capacity and appropriate ratios


· The Licensee is present in the home and has ensured that children in care are supervised.
· When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children
· A working telephone is present.
· Appropriate fire extinguisher located in the kitchen next to the back door, smoke detector and carbon monoxide detector are present and were tested by the Licensee during this inspection on 04/14/2022.
· All hazardous items are inaccessible, this includes detergents, cleaning compounds, medications and other items which could pose a danger to children
· Storage of poisons is inaccessible to children and locked
· There is a properly barricaded fireplace on 04/14/2022
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2022
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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: GRAY-ROBINSON FAMILY CHILD CARE
FACILITY NUMBER: 336300298
VISIT DATE: 04/14/2022
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· No guns or weapons present as stated by the Licensee Sasha Gray-Robinson. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations.
· Stairs are NOT barricaded at this time for the outdoor landscape where LPA and LPM observed 2 staircases leading up to the retaining wall that platforms at approximately 4 feet high and does not have railing guards or fencing to prevent a child from falling. The licensee stated that they will look into placing a barrier to the two stair ways leading to the retaining wall.
· Home is clean and orderly, with heating and ventilation for safety and comfort
· Safe and appropriate toys and equipment are present for both indoor and outdoor activities.
· Outdoor play areas are fenced and/ or appropriate supervision is present, consultation provided to licensee regarding landscaping stairs leading up to the retaining wall.
· Verification of control of property on file.
· Property owner/landlord notification and consent on file.
· Pediatric CPR and First Aid training completed on 09/15/2020 Card expire on 09/2022
· Health & Safety Certificate - completed on 09/27/2022
· Mandated reporter: General: Child Care Expires: 01/19/2023
· Documentation of fire & earthquake drills to be conducted every six months: Last drill on 09/25/2021, with 8 children in care, lasted 12 minutes and evacuated next door, in the front driveway.
· There are no bodies of water, on 04/14/2022. 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
· Children’s files are complete on 04/14/2022.
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.

For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022
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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: GRAY-ROBINSON FAMILY CHILD CARE
FACILITY NUMBER: 336300298
VISIT DATE: 04/14/2022
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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

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.

LPM Pauline Beschorner, discussed the safe sleep regulations with licensee Sasha Gray-Robinson 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Sasha Gray-Robinson.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022
LIC809 (FAS) - (06/04)
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