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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300691
Report Date: 05/23/2024
Date Signed: 05/23/2024 01:22:25 PM

Document Has Been Signed on 05/23/2024 01:22 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:FRYE FAMILY CHILD CAREFACILITY NUMBER:
336300691
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
05/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:01 PM
MET WITH:Destiny Frye TIME VISIT/
INSPECTION COMPLETED:
01:35 PM
NARRATIVE
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On May 23, 2024, at 12:01 PM, Licensing Program Analyst’s (LPAs) Anastasia Flores and Courtnee Peebles, arrived for the purpose of opening up a complaint investigation for the Frye Family Child Care. During the inspection, LPA’s reviewed records and toured the facility inside and out with licensee and the following health and safety concerns were noted and photos were taken, which resulted in a separate case management deficiency issued separate from the complaint investigations.

Outlets in kitchen, downstairs bedroom were not covered with safety covers. Sharp items, such as knives, can openers, scissors, wine opener, and potato peeler were in a drawer in the center island. Licensee did not have a sleep log for the infants in care under the age of 24 months. Records reviewed revealed that licensee did not have two out of two staff files on hand at time of inspection. Licensee stated the records are online but could not provide evidence at time of inspection. Records reviewed disclosed that licensee did not have files for three out of six children present at time of inspection. Licensee stated the files are online, could not provide evidence of records at time of inspection. Records reviewed revealed that licensee did not have immunization's on file for four out of six children’s files at time of inspection. Records reviewed revealed that licensee did not have five out of six children present did not have LIC627, emergency consent form, on file at time of inspection. Records reviewed revealed that five out of six children did not have LIC995A, parents rights on file at time of inspection.

Based on records review and LPA’s observations, the facility is being cited for: Title 22, division 12, Chapter1,Article 06, section: 102481(a) Immunizations, 102421 (a) Child’s Records, 102416.1(d) Personnel Records, 102425 (c)Infant Safe Sleep, 102425 (j)(D) Infant Safe Sleep and 102416(a)Personnel Requirements, see 809D for deficiencies.

Exit interview was conducted, and a copy of this report, 809D’s and appeal rights were provided to licensee, Destiny Frye.

A notice of site visit was provided and licensee was informed it must be posted for 30 days.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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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Document Has Been Signed on 05/23/2024 01:22 PM - It Cannot Be Edited


Created By: Anastasia Flores On 05/23/2024 at 12:37 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: FRYE FAMILY CHILD CARE
FACILITY NUMBER: 336300691

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/30/2024
Section Cited
CCR
102425(c)

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102425 (c) Infant Safe Sleep An Individual Infant Sleeping Plan LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file.
this was not met as evidenced by....
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Licensee will obtain an infant safe sleep plan for child #5, and provide to LPA Peebles via email by 05/30/24.
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Based on record review and interview with licensee, one infant did not have an infant safe sleep plan on file at time of inspection. This poses a possible health safey and personal rights risk to children in care.
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Type B
05/30/2024
Section Cited
CCR102425(j)(D)

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102425 (j)(D) INFANT SAFE SLEEP; The provider shall supervise infants while they are sleeping and adhere to the following requirements: Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Date, infant’s name, time of each 15-minute check.This was not met as evidenced by....
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Licensee will obtain and begin to an infant safe sleeplog and send one week record to LPA Peeble via email by 05/30/24.
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Based on record review and interview, the licensee did not have infant sleep log for four infants in care at the time of inspection. This poses a possible health safey and personal rights risk to children in care.
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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:Pauline Beschorner
LICENSING EVALUATOR NAME:Anastasia Flores
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/23/2024 01:22 PM - It Cannot Be Edited


Created By: Anastasia Flores On 05/23/2024 at 12:42 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: FRYE FAMILY CHILD CARE
FACILITY NUMBER: 336300691

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/30/2024
Section Cited
CCR
102416.1(d)

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102416.1 (d)Personnel Records; All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review. This was not met as evidenced by...
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Licensee will obtain personnel records for staff hired at the Family Child Care, and send copies of records to LPA Peebles by 05/30/24.
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Based on record review and interview licensee does not have personnel records for two out of two staff present at time of inspection. This poses a possible health safey and personal rights risk to children in care.
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Type B
05/30/2024
Section Cited
CCR102421(a)

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102421(a) Child's Records; The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).this was not met as evidenced by....
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Licensee will retreive records for children in care and provide copies of records to LPA Peebles by 05/30/24.
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Based on Record review and interview, licensee stated she has the files online, was not able to present all records at time of inspection for three out of six children present at time of inspection. This poses a possible health safey and personal rights risk to children in care.
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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:Pauline Beschorner
LICENSING EVALUATOR NAME:Anastasia Flores
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/23/2024 01:22 PM - It Cannot Be Edited


Created By: Anastasia Flores On 05/23/2024 at 12:47 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: FRYE FAMILY CHILD CARE
FACILITY NUMBER: 336300691

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/30/2024
Section Cited
CCR
102418(a)

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102418(a) Immunizations; Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This was not met as evidenced by...
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Licensee will obtain immunizations for all children in care and submit evidence via email to LPA Peebles.
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Based on record review and interview, licensee did not have immunization records for four out of six children in care at the time of inspection. This poses a possible health safey and personal rights risk to children in care.
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Type B
05/30/2024
Section Cited
CCR102416(a)

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102416(a)Personnel Requirements; The licensee shall provide each employee with a copy of the Notice of Employee Rights (LIC 9052 (4/88)) form furnished by the Department. This was not met as evidenced by....
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Licensee will have staff complete all records required and submit records to LPA Peebles via email by 05/30/24.
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Based on interview and record review, the licensee did not have records for staff present at time of inspection. This poses a possible health safey and personal rights risk to children in care.
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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:Pauline Beschorner
LICENSING EVALUATOR NAME:Anastasia Flores
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2024


LIC809 (FAS) - (06/04)
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