Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334818074
Report Date: 10/07/2016
Date Signed: 10/07/2016 12:39:49 PM

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:FSA-HEMET CDCFACILITY NUMBER:
334818074
ADMINISTRATOR:MICHELE CARRASCOFACILITY TYPE:
830
ADDRESS:41931 E. FLORIDA AVE.TELEPHONE:
(951) 925-2160
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:24CENSUS: 4DATE:
10/07/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Maria Gomez, Lead Teacher and Mary Hampton Specialist.TIME COMPLETED:
12:45 PM
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On the date and time listed above, Licensing Program Analyst (LPA) Sharleen Robinson conducted an annual visit at this facility. LPA met with Lead teacher Maria Gomez, Specialist Mary Hampton. LPA and Lead toured the facility both inside and out, the following was observed:

· The facility is operating within the terms of the license
· Ratios were met during this visit
· Appropriate supervision was provided during the visit
· Rooms are physically separated from other components
· Rooms are equipped with age appropriate furniture and equipment in good condition
· Napping equipment meets licensing requirements.
· Rooms are clean and free of hazards
· No weapons stored at the facility
· Medications are stored where inaccessible to infants
· Hazards are stored where inaccessible to infants
· Toxins are locked
· Toileting area was observed to be safe, sanitary and in operating condition
· Outdoor play area is physically separated by appropriate fencing and free of hazards
· Outdoor activity areas are supplied with age and size appropriate equipment in good condition
· Food preparation area is clean and free of vermin
· Food is stored appropriately and protected from contamination
· Individual feeding plans were reviewed
· Infant needs and services plans were reviewed
· Sign in/Sign out record was reviewed and meets regulation requirements
· Staff member’s CPR/First Aid expires on 3/2017.
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4950
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2016
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: FSA-HEMET CDC
FACILITY NUMBER: 334818074
VISIT DATE: 10/07/2016
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AB 2621 – Public Information effective January 1, 2015 – The Department shall post licensing information for Child Care Facilities on its internet Web site to include:
o The name
o The address for each Child Care Center only
o The status of the license
o The capacity of the license for each Child Care Center only

*HSC 1596.7995.(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

(2) If a person meets all other requirements for employment or volunteering, as applicable, but needs additional time to obtain and provide his or her immunization records, the person may be employed or volunteer conditionally for a maximum of 30 days upon signing and submitting a written statement attesting that he or she has been immunized as required.



No deficiency cited, an exit interview was conducted, Notice of Site visit provided and a copy of this report was provided to Specialist Mary Hampton on this date.
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4950
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2016
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: FSA-HEMET CDC
FACILITY NUMBER: 334818074
VISIT DATE: 10/07/2016
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The facility is providing Incidental Medical Services (IMS); the IMS plan is on file, however there are no infants currently in care who require IMS. Medications are stored in the kitchen, locked in a cabinet.

The Specialist was advised:


· Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.
· AB 978 – Zero Tolerance Related Regulations went into effect January 18, 2011 – In accordance with California Health and Safety Code Section 1596.99(c)/1597.58(c) – it was explained that an immediate $150 Civil penalty will be assessed for each serious violation and a civil penalty of $150 per day per violation will be assessed until corrected.

· AB 2084 - Nutritious Beverages in Child Care Facilities effective January 1, 2012 - was explained that only low-fat or non-fat milk is to be served to children 2 years of age or older; and limit juice to one serving of 100% juice per day; serve no beverages with added sweeteners; and water must be available and accessible to children throughout the day

· ·AB 2386 – effective 1/1/2015, requires community care facilities to have one or more functioning carbon monoxide detectors that meet specified statutory requirements in the facility and requires the Department to account for the presence of the detectors during inspections

· ·AB 2236 – increases the amount of civil penalties that may be imposed for a violation that results in the death of, or serious bodily injury or physical injury to, a client.

· ·HSC 1597.54(h) Incidental Medical Services. Director instructed to visit the CCLD web site at www.ccld.ca.gov See LIC809C for the remainder of the report.
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4950
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2016
LIC809 (FAS) - (06/04)
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