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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842493
Report Date: 05/03/2023
Date Signed: 05/03/2023 04:01:15 PM

Document Has Been Signed on 05/03/2023 04:01 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:FOSTER FAMILY CHILD CAREFACILITY NUMBER:
364842493
ADMINISTRATOR:FOSTER, LOLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 616-2431
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
05/03/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Lola FosterTIME COMPLETED:
04:25 PM
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On 05/03/2023 Licensing Program Analysts (LPAs) Laura Mejorado and Justin Giese made an unannounced visit to the facility for another purpose. LPAs met with Licensee Lola Foster, who stated the facility was closed today and the seven children present were blood related family. The following was discussed:

LPA’s requested to review Children’s files and current facility roster. Licensee stated they did not have files available for daycare children nor a current roster to review.

LPA’s observed personal hygiene products and medications located in the on-limits bathroom, a large knife on the kitchen counter, unsecured laundry room with accessible detergents and uncovered barbecue grills and lighter fluid in the on-limits backyard area.



LPA’s observed three children in care at the time of the tour, later during the visit an additional four children arrived. According to Licensee, all children in attendance are family and of blood relation. Licensee stated they do not currently have daycare children enrolled at the facility. Licensee was reminded to maintain the accessibility of potential hazardous items regardless of children in care.

Therefore, based on Licensee’s own admission, lack of records reviewed, and LPA's observations the Facility was found to be in violation of the following Title 22 Regulations:

Please see LIC809C.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
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 4
Document Has Been Signed on 05/03/2023 04:01 PM - It Cannot Be Edited


Created By: Laura Mejorado On 05/03/2023 at 02:24 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: FOSTER FAMILY CHILD CARE
FACILITY NUMBER: 364842493

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2023
Section Cited
CCR
102417(g)(4)

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(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be 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. This was not met as evidenced by:
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Licensee agrees to remove/make dangers items inaccessible and maintain the home free of any conditions which may endanger a child. Licensee agrees to submit proof to CCL by 5/17/23.
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LPA’s observed personal hygiene products and medications located in the on-limits bathroom, a large knife on the kitchen counter, unsecured laundry room with accessible detergents and uncovered barbecue grills and lighter fluid in the on-limits backyard area. This poses 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:Kimberly Williams
LICENSING EVALUATOR NAME:Laura Mejorado
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/03/2023 04:01 PM - It Cannot Be Edited


Created By: Laura Mejorado On 05/03/2023 at 02:14 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: FOSTER FAMILY CHILD CARE
FACILITY NUMBER: 364842493

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2023
Section Cited
CCR
102417(g)(7)

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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…
This was not met as evidenced by:
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Licensee stated they are aware they need to keep complete, accurate and separate files for all daycare children. Licensee will be required to draft a written acknowledgement regarding this regulation, stating they will maintain children’s records for all daycare children currently enrolled or enrolled in the future.
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LPA’s requested to review Children’s files and current facility roster. Licensee stated they did not have files available for daycare children to review. This poses a potential health/safety, or personal rights risk to persons in care.
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Licensee will submit acknowledgement to CCL on or before the stated POC date 05/17/2023.
Type B
05/17/2023
Section Cited
CCR1596.841

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1596.841 Current roster of children provided care in facility required
Each child day care facility shall maintain a current roster of children who are provided care in the facility… This roster shall be available to the licensing agency upon request.

This was not met as evidenced by:
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Licensee stated they are aware they need to keep and maintain a current Facility Roster for all past and present daycare children. Licensee will be required to draft a written acknowledgement regarding this regulation, stating they will maintain a Facility Roster.
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LPA’s requested to review current facility roster. Licensee stated they did not have a current roster to review. This poses a potential health/safety, or personal rights risk to persons in care.
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Licensee will submit acknowledgement to Licensing on or before the stated POC date 05/17/2023
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:Laura Mejorado
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023


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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: FOSTER FAMILY CHILD CARE
FACILITY NUMBER: 364842493
VISIT DATE: 05/03/2023
NARRATIVE
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102417 Operation of a Family Child Care Home
(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

1596.841 Current roster of children provided care in facility required
Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.

102417 Operation of a Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be 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.

This poses a potential health/safety, or personal rights risk to persons in care. SEE LIC809D for Type B Deficiencies.

LPA's provided Licensee the following: Roster LIC9040 and Identification And Emergency Information Child Care Centers/Family Child Care Home LIC700.

Notice of Site visit was issued and must be posted for 30 days.

An exit interview was conducted, a copy of this report and appeal rights were given to the Licensee during this inspection on 05/03/2023.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC809 (FAS) - (06/04)
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