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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336301317
Report Date: 03/13/2025
Date Signed: 03/13/2025 09:56:50 AM

Document Has Been Signed on 03/13/2025 09:56 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MATTHEWS FAMILY CHILD CAREFACILITY NUMBER:
336301317
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/13/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Kimberly Matthews, ApplicantTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Jesse Gardner conducted an announced pre-licensing inspection for a small family childcare at the above home on 03/13/2025 at 08:30 AM. LPA met with Applicant Matthews, who guided LPA on a tour of the home. There were no child present when LPA arrived. Applicant is applying for a small child care license. Per Applicant, hours of operation will be Monday through Friday 7:00 AM 12:00 AM. Applicant states they will provide care for children 6 weeks to 12 years of age.

This is a two-story home consisting of 4 bedrooms, 2 bathrooms, a living room, kitchen, dining room, day care room, Art Room, front yard and backyard. The home was inspected for safety, cleanliness, telephone service, heating and ventilation. Poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children are kept inaccessible; however, not behind a lock. Licensee states they will purchase a lock and advise LPA upon completion.

Areas used by children include: The play room, bathroom #1, Art Room (Living Room #2) (located to the side of the kitchen), and backyard. Areas off limits include: three bedrooms, one bathroom, garage, and kitchen. Off limit areas are made inaccessible by door locks/baby gates/door knob covers. Knives and other sharp utensils are locked in a kitchen cabinets and drawers. Cleaning products will be made inaccessible by a key lock.
The home is clean, neat, and orderly, there are outlet covers throughout the home. Smoke/carbon monoxide detector was observed, and after testing, LPA found that the detector is inoperable and in need of replacement. Applicant will replace and notify LPA upon completion.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MATTHEWS FAMILY CHILD CARE
FACILITY NUMBER: 336301317
VISIT DATE: 03/13/2025
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Applicant has completed the required preventative health and safety course which includes nutrition and prevention of lead exposure, and the Pediatric First Aid and CPR. Applicant has proof of immunizations on file. Proof of Mandated Reporter Training was also provided.

LPA observed age-appropriate toys and learning materials. The required (2A-10BC) fire extinguisher was not observed, as Applicant has their extinguisher at their other licensed facility. Applicant states they will purchase one and provide proof of such to LPA. When obtained, LPA reminded applicant that the fire extinguisher must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, batteries should be replaced.

Per Applicant, there are not any weapons or firearms in the facility.

According to the applicant, the children will use the backyard for outdoor play. The outdoor play area was observed to be fenced. LPA noted that the yard does not contain toys and other play materials at this time; however, when Applicant closes their other facility they will provide proof of outdoor play equipment. Additionally, LPA observed an area of soft turf that will be utilized for play. No hazardous objects were observed in the outdoor area.

There are not any pools, spas, or other bodies of water.

The isolation area for a sick child waiting to be picked up will be in an area of the Art Room that will be away from other children. LPA reviewed with applicant the LIC311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Applicant was provided copies of the required forms.


SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MATTHEWS FAMILY CHILD CARE
FACILITY NUMBER: 336301317
VISIT DATE: 03/13/2025
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APPLICANT LEASES THE HOME:

The applicant provided proof of control of property.

APPLICANT LEASES THE HOME AND HAS LANDLORD CONSENT:

Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC9149).

Applicant 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.



LPA informed Applicant(s) of their reporting requirements. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. The Duty Officer is available to answer questions Monday – Friday 8:00am to 5:00pm at: 951-782-4200. In addition, a report can be emailed to UnusualIncidentReportsDO10@dss.ca.gov.

Fire and safety drills must be performed every six months and documented for review by the Department. Smoking is not allowed in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present.

A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.

Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC809 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MATTHEWS FAMILY CHILD CARE
FACILITY NUMBER: 336301317
VISIT DATE: 03/13/2025
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Changes should be reported to the Department as soon as they occur such as construction and remodeling, telephone number changes and/or if you move from the home.

Applicant states they will provide food for the children.

CHILDREN'S RECORDS REQUIREMENTS:


• LIC 700 Identification and Emergency Information
• LIC 627 Consent for Emergency Medical Treatment
• LIC 282 Affidavit Regarding Liability Insurance
• LIC 9150 Parent Notification Additional Children in Care
• LIC 9927 Individual Infant Sleeping Plan
• LIC 995A Notification of Parent’s Rights
• Immunization Record

FACILITY RECORDS:
• LIC 624B Unusual Incident/Injury Report
• LIC 9040 Child Care Facility Roster
• LIC 9052 Employee Rights,
• LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
• LIC 9149 Property Owner/Landlord Consent Form
• LIC 9151 Property Owner/Landlord Notification Form
• Proof of current pediatric CPR and First Aid Certificates
• Copy of your deed or lease/rental agreement
• Documentation of Fire and Disaster drills
• Proof of immunizations against pertussis (TDAP), measles (MMR), and influenza
• Mandated Reporter certificate – www.mandatedreporterca.com– must be renewed every two (2) years

FORMS TO BE POSTED
• LIC203 Facility License
• PUB394 Notification of Parents Rights Poster
• PUB 475 1-844-LET-US-NO
• LIC 610A Emergency Disaster Plan (Recommended)
• LIC 9148 Earthquake Preparedness Checklist (Recommended)
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
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 SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MATTHEWS FAMILY CHILD CARE
FACILITY NUMBER: 336301317
VISIT DATE: 03/13/2025
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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) or (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.

Applicant(s) was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.



LPA discussed the safe sleep regulations with applicant 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 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.

On this date, 03/13/2025, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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 platforms.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MATTHEWS FAMILY CHILD CARE
FACILITY NUMBER: 336301317
VISIT DATE: 03/13/2025
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To receive important licensed related information to licensed facilities, visit the CCLD Important Information website https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA will submit a the application for approval once the following is Completed:

1. Smoke Detector/Carbon Monoxide Detector.

2. Fire Extinguisher (2A-10BC)

3. Outdoor play equipment in backyard

4. Applicant will provide locks for their chemical storage

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 denied.

An exit interview was conducted, and a copy of this report was reviewed with and handed to Applicant Kimberly Matthews.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC809 (FAS) - (06/04)
Page: 6 of 6