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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841672
Report Date: 11/20/2024
Date Signed: 11/20/2024 05:54:33 PM

Document Has Been Signed on 11/20/2024 05:54 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MURRELL FAMILY CHILD CAREFACILITY NUMBER:
364841672
ADMINISTRATOR/
DIRECTOR:		KONSTANCE MURRELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 733-9015
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92411
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
11/20/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:45 PM
MET WITH:Konstance MurrellTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
NARRATIVE
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On date and time listed above, Licensing Program Analyst (LPA) Justin Giese, arrived at the facility unannounced for another purpose. LPA was granted access to the facility and met with Licensee, Konstance Murrell. The following was discussed:

On 06/21/2024, LPA made unannounced visit to facility for another purpose. During this visit, LPA reviewed pertinent facility documents. Licensee was issued a type B deficiency for staff records. Licensee was unable to provide immunization records for their assistant.

Based on Licensee and staff interview/records reviewed, Licensee was unable to provide LPA with missing staff immunization records noted from previous visit. This deficiency has been outstanding without correction. Due to missed POC date the deficiency will be cited again during today's visit. The facility was found be in violation of the following regulation:

HSC 1597.622(a)(1)
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles....

This is a repeat violation, a civil penalty of $250 will be assessed for staff records (immunizations)

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

Exit interview was conducted and report and appeal rights reviewed with Licensee, Notice of site visit was issued and must remain posted for a period of 30 days.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
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 11/20/2024 05:54 PM - It Cannot Be Edited


Created By: Justin Giese On 11/20/2024 at 05:16 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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: MURRELL FAMILY CHILD CARE
FACILITY NUMBER: 364841672

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2024
Section Cited
HSC
1597.622(a)(1)

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(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles....

This was not net as evidenced by:
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Licensee will submit immunization records for Staff to LPA on or before the stated POC date of 12/20/2024. Submission can be sent via email.

justin.giese@dss.ca.gov
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Based on observation and record review, the licensee did not comply with the section cited above, LPA was unable to verify Staff's immunizations records, Licensee did not obtain immunization records from previous citation which poses a potential health, safety or personal rights risk to persons in care.
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This is a repeat violation. A civil penalty of $250 will be assessed.

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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:Justin Giese
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2024


LIC809 (FAS) - (06/04)
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