364841385-4-25-2024-09-CC-ALAA-D4NNQG-20240425103956

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364841385
Report Date: 04/25/2024
Date Signed: 04/25/2024 10:40:04 AM

Document Has Been Signed on 04/25/2024 10:40 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:	BURNS FAMILY CHILD CARE		FACILITY NUMBER:	364841385
ADMINISTRATOR/ DIRECTOR:	BURNS, ARLISSIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 427-0802
CITY:	FONTANA	STATE: CA	ZIP CODE:	92337
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 13	CENSUS: 3	DATE:	04/25/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:40 AM
MET WITH:	Arlissia Burns		TIME VISIT/ INSPECTION COMPLETED:	10:50 AM

NARRATIVE

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On the date and time listed, Licensing Program Analyst (LPA) Aman Lama arrived at the facility to conduct an annual inspection. Upon arrival, LPA was met with licensee, Arlissia Burns. Licensee granted access to LPA who then toured the facility, both inside and outside.

Normal days and hours of operation are listed as: Monday-Friday 5:30am-5:30pm
OFF LIMIT AREAS INCLUDE: Master Bedroom, Living room, Dining room, garage and entire 2^nd floor. In the outdoor area, the pool and patio cover in the left corner is off limits.
· Licensee understands the licensed capacity and appropriate ratios.
· A working telephone is present and current phone number is on file.

· Appropriate fire extinguisher, smoke detector and carbon monoxide detector were all in working order.

· There were some hazards and toxins accessible, however, no children were present.

· No guns/weapons currently kept in the home. All guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations.

· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster were posted in the home.

· Mandated Reporter Training certificate for licensee expires 07/25.

· Pediatric CPR and First Aid Card for licensee expires 07/25.

· Health & Safety Certificate has been completed by licensee and is on file.

· LPA observed Clean, safe and age appropriate toys available for children.

· Documentation of last fire/disaster drill was conducted: 12/01/2023.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

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: BURNS FAMILY CHILD CARE	FACILITY NUMBER: 364841385
	VISIT DATE: 04/25/2024

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·Bodies of water were observed on property at this time. All bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains were observed to be properly fenced per Title 22 Regulations. The Department must be notified before and after installation of any 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.

· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov

· Resident and/or staff records reviewed indicate that all adults who require caregiver background checks have received all required clearances or exemptions.

· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations862@dss.ca.gov

- LPA reminded licensee of the safe sleep regulations and discussed the Child Care Licensing Safe Sleep webpage as an additional resource at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep

-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.

-Licensee is not currently administering medications. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes 102417. 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

- The 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.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

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: BURNS FAMILY CHILD CARE	FACILITY NUMBER: 364841385
	VISIT DATE: 04/25/2024

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- Go to the licensing webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.

- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at: 951-782-4200.

The Licensee, Arlissia Burns confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

Exit interview conducted and report was reviewed with the licensee, Arlissia Burns.

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

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/25/2024 10:40 AM - It Cannot Be Edited

Created By: Aman Lama On 04/25/2024 at 10:24 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: BURNS FAMILY CHILD CARE	FACILITY NUMBER: 364841385
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/25/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(i)

Infant Safe Sleep

If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Upon arrival, LPA observed an infant sleeping in a baby rocker, but the infant woke up immediately, taking the immediate risk away. This has been downgraded to a Type B violation due to the child voluntarily waking up right away. This still poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/03/2024
	Plan of Correction
1 2 3 4	Licensee agrees to watch the free videos on ccld.ca.gov available to the public regarding Safe Sleep and send the department a written understanding of the videos pertaining to safe sleep. Additionally, licensee agrees to refresh on the Safe Sleep Regulations, provided during todays inspection.

Type B

Section Cited

CCR

102425(j)(2)(D)(c)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above. Although the licensee has 15 minute checks on file, they have not been updated since December of 2023. This poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/03/2024
	Plan of Correction
1 2 3 4	Licensee agrees to watch the free videos on ccld.ca.gov available to the public regarding Safe Sleep and send the department a written understanding of the videos pertaining to safe sleep. Additionally, licensee agrees to refresh on the Safe Sleep Regulations, provided during todays inspection.

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:

Kimberly Williams

LICENSING EVALUATOR NAME:

Aman Lama

LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC809 (FAS) - (06/04)

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