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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842493
Report Date: 08/02/2023
Date Signed: 08/02/2023 02:57:17 PM

Document Has Been Signed on 08/02/2023 02:57 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: 5DATE:
08/02/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:24 AM
MET WITH:Lola FosterTIME COMPLETED:
03:15 PM
NARRATIVE
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On this date and time, Licensing Program Analysts (LPAs) Laura Mejorado and Susan Brewer arrived at the facility to conduct an inspection regarding a separate matter. LPA’s met with Licensee Lola Foster, also present were two daycare children and three blood related children. LPA’s toured the home and the following was discussed:

While touring the facility LPA’s observed hazardous items in the daycare area of the backyard. Hazardous items included two gasoline tank containing gasoline with no lid, tools (shovel and rake), spoiled bottle of milk, broken toys, and a lawn mower. No children were present in the backyard at the time of the inspection; however, the backyard is not off limits and children have access.

Therefore, based on LPA's observations the Facility was found to be in violation of the following Title 22 Regulation:

102417 Operation of a Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child.

See LIC809D for cited deficiency of the California Code of Regulations, Title 22.


Exit interview conducted and report was reviewed with Licensee Lola Foster.

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

A copy of this report must be made available to the public, at the facility site, for 3 years.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2023
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 08/02/2023 02:57 PM - It Cannot Be Edited


Created By: Laura Mejorado On 08/02/2023 at 01:44 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: 08/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/03/2023
Section Cited
CCR
102417(g)

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102417 Operation of a Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child.

This was not met as evidenced by:
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Licensee stated they will have the backyard cleaned today. During inspection Licensee had a someone come and start cleaning the backyard. Licensee agrees to submit pictures of items removed to CCL by 8/3/23.
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Based on observations, LPAs observed two gasoline tank containing gasoline with no lid, tools (shovel and rake), spoiled bottle of milk, broken toys, and a lawn mower in the backyard, which poses a potential Health, Safety, or Personal Rights risk to persons in care. No children were present in the backyard at the time of the inspdction.
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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: 08/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2023


LIC809 (FAS) - (06/04)
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