<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842493
Report Date: 07/20/2022
Date Signed: 07/20/2022 01:39:11 PM

Document Has Been Signed on 07/20/2022 01:39 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: 0DATE:
07/20/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Lola FosterTIME COMPLETED:
01:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 07/20/2022, at time listed above, an informal conference was held at the Riverside Regional Office. Present in the conference were Licensee Lola Foster, Licensing Program Manager (LPM) Gilbert Sena and Licensing Program Analyst (LPA) Justin Giese.

The Purpose of the meeting is to review and discuss the following:
• Operation of a Family Child Care Home
• Criminal Records Clearance
• Records Keeping
• Personal Rights
• Posting Requirements

Facility's compliance history was reviewed during this conference. During this conference, LPM and LPA introduced the Child Care Technical Support Program (TSP) and informed Licensee, that TSP is a voluntarily program to assist facilities with meeting and maintaining the requirements of operating a licensed childcare facility. Licensee will review and reach out to Licensing at a later date.

During today's conference, the following regulations and documents were discussed and provided to Director/Licensee.

Regulations:
102417 Operation of a Family Child Care Home
102423 Personal Rights
102370 Criminal Record Clearance
HSC 1596.8555 Posting of License
102416.1 Personnel Records
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2022
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 2
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: 07/20/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Documents Provided:
Copy of Licensee Immunizations, Copy of Licensee Health and Safety Certificate, LIC9224 for prior Type A citations and Today’s Office Conference, Copy of Facility Emergency Disaster Plan, Copy of facility sketch, PUB394 Notification of Parents Rights, LIC9148 Earthquake Preparedness Checklist, PUB269 California Child Passenger Safety Law, practice emergency drills log, LIC9040 Child Care Facility Roster, Mandatory Forms for Family Child Care Homes: LIC627 Consent for emergency medical treatment, LIC700 Identification and Emergency Information, LIC262 Affidavit Regarding Liability Insurance, LIC613A Personal Rights, LIC995A Parents Rights, Guide to child care Ratios (small/large), Checklist for child care assistant or adult residing in home, LIC9052 Employee Rights, What is TSP guide and PIN 22-21-CCP Child Care Licensing Webinars

The following outstanding corrections are needed to clear Deficiencies cited on 05/18/2022 and 05/22/2022:


  • Immunizations - MMR (Licensee)
  • Immunizations - MMR, Tdap (Staff)
  • TB test (Staff)
  • Receipt for pest termination services


Licensee was advised to visit the Department's website at: https://cdss.ca.gov/inforesources/child-care-licensing/resources-for-providers on a regular basis for licensing updates. Licensee was advised to review Child Care Provider videos related to: Record Keeping in Family Childcare, Background Check Requirements for Caregivers, Locks and Inaccessability Requirements in Child Care and What is a Civil Penalty? Family Child Care Providers video website link was provided during this conference https://ccld.childcarevideos.org/family-child-care-providers/

Additionally, LPA Giese informed the Licensee to provide a copy of this licensing report dated 07/20/2022 to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2