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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364803359
Report Date: 10/02/2024
Date Signed: 11/06/2024 08:52:23 AM

Document Has Been Signed on 11/06/2024 08:52 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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MARCY FAMILY CHILD CAREFACILITY NUMBER:
364803359
ADMINISTRATOR/
DIRECTOR:		LISA MARCYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 428-1150
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/02/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Lisa Marcy and Chad Marcy, assistant TIME VISIT/
INSPECTION COMPLETED:
12:20 PM
NARRATIVE
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On the date and time listed above, Licensing Program Analysts (LPAs) Aman Lama and Justin Giese made an unannounced visit to the facility for the purpose of Proof of Corrections (POCs) from an unannounced inspection conducted on 03/29/2024. LPA's met with licensee, Lisa Marcy and discussed the purpose of the visit.

The following citations were cleared during todays visit:

1.102417(g)(4) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

2.1596.8662(b)(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

3. 102417(g)(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

4.102417(m)(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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: MARCY FAMILY CHILD CARE
FACILITY NUMBER: 364803359
VISIT DATE: 10/02/2024
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The following citation is still pending and has not been corrected, classifying this as a repeat violation. -SEE LIC 809D for more information.

A Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.



A copy of the Health and Safety Code (H&S) section 1597.622 was provided to the assistant for review.

The purpose of the visit and corrections were discussed with licensee, however, licensee exited the facility at 11:40am, therefore exit interview was conducted with assistant, Chad Marcy.

A notice of site visit was printed and handed to assistant, Chad Marcy.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/02/2024 12:08 PM - It Cannot Be Edited


Created By: Aman Lama On 10/02/2024 at 11:52 AM
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: MARCY FAMILY CHILD CARE
FACILITY NUMBER: 364803359

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2024
Section Cited
HSC
1597.622(a)(1)

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(1) Commencing September 1, 2016, a person shall not be employed/volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee/volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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Licensee agrees to submit proof of immunizations (measles, pertussis, flu shot or declination of flu shot) for assistant to licensing no later than the POC due date.
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This requirement is not met as evidenced by:
Based on record review, the licensee did not comply with the section cited above. Assistant does not have immunizations on file. This poses/posed a potential health, safety or personal rights risk to persons 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:Gilbert Sena
LICENSING EVALUATOR NAME:Aman Lama
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2024


LIC809 (FAS) - (06/04)
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