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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300298
Report Date: 07/25/2022
Date Signed: 07/25/2022 03:58:27 PM

Document Has Been Signed on 07/25/2022 03:58 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: 8CENSUS: DATE:
07/25/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:34 PM
MET WITH:Licensee Sasha Gray RobinsonTIME COMPLETED:
04:10 PM
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On 07/25/2022 at 1:50 PM, Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to conduct a Case Management inspection. The licensee Sasha Gray-Robinson, has applied to increase her capacity to that of a Large Family Child Care Home. Licensing Program Analyst (LPA) Susan Brewer, toured the facility, inside and out, records were reviewed and the following was observed: Present were the licensee and 2 resident children over the age of 10 years old. LPA conducted a census of 2 daycare children and 2 resident children under the age of 10 present.

· Normal days and hours of operation are: Monday-Friday, 6:00 AM to 6:30 PM
· OFF-LIMIT AREAS INCLUDE: Laundry Room, Garage and entire 2nd Floor.

· Appropriate fire extinguisher, smoke detector and carbon monoxide detector are present and were tested by the licensee during this inspection 07/25/2022..
· All hazardous items inaccessible on 07/25/2022.
· Toxins locked on 07/25/2022.
· No guns or weapons present as on 07/25/2022. The Licensee Applicant Sasha Gray - Robinson understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations.
· Stairs are barricaded on 07/25/2022.
· The fireplace is properly screened on 07/25/2022.
· Verification of control of property on file.
· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights forms are posted.
· Pediatric CPR and First Aid Completed on 09/15/2020, Card - expires on 09/2022
· Health & Safety Certificate - completed on 09/27/2020
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2022
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: 07/25/2022
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· There are no bodies of water on 07/25/2022. Licensee Sasha Gray-Robinson, 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 on 07/25/2022.
· There are no toxic plants observed on 07/25/2022.
· Current roster on file on 07/25/2022.
· Documentation of fire drills on file 03/25/2022 with 6 children and lasted 10 minutes.
· Children’s records are complete on 07/25/2022.
· Employee’s records are NOT complete. The licensee is in the process of hiring an employee.
· Mandated reporter: General: 07/25/2022; AB1207 Childcare Provider expires: 01/2023
· Fire clearance received by the fire department on 06/21/2022.

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 07/25/2022 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.

The Applicant was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov

Incidental Medical Services (IMS) policy was discussed with Sasha Gray Robinson. 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 Sasha Gray Robinon, 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
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022
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: 07/25/2022
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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.

The Licensee Applicant Sasha Gray Robinson, 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, LIC508 and TB Screening 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.

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

DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022
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: 07/25/2022
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- 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 renewing 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 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,
- 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.

The Duty Officer is available to answer questions Mon. – Fri.at 1-844-LET-US-NO (1-844-538-8766).

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.

During the exit interview, the Licensee Applicant Sasha Gray Robinson, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

No citations issued on 07/25/2022.

No civil penalties issued on 07/25/2022.

Exit interview conducted and report was reviewed with the Licensee Applicant Sasha Gray Robinson.

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

DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022
LIC809 (FAS) - (06/04)
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