Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364814242
Report Date: 12/13/2016
Date Signed: 12/13/2016 01:40:47 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:BOOKER FAMILY CHILD CAREFACILITY NUMBER:
364814242
ADMINISTRATOR:BOOKER, REGINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 346-0606
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY:14CENSUS: 6DATE:
12/13/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Regina BookerTIME COMPLETED:
01:55 PM
NARRATIVE
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A Random Annual (3) visit is being conducted as a compliance review. Licensee, Regina Booker granted LPA Joanne Domingo access into the home then left to pick up a school age child. LPA, Joanne Domingo toured the facility, inside and out, and the following was observed:
· The facility is operating within the licensed capacity and appropriate ratios YES
· The licensee is present in the home and ensures that children in care are supervised at all times. When temporarily absent from the home, the licensee arranges for a substitute adult to care for and supervise children in their absence. ASSISTANT/MOTHER, KARLA BELLAMY PRESENT SUPERVISING 5 NAPPING CHILDREN
· Each child has safe, healthful, and comfortable accommodations, furnishings, and equipment YES
· Children are not left in parked vehicles YES
· Appropriate fire extinguisher (UNDER KITCHEN SINK) and smoke detector present (DOWNSTAIRS HALLWAY)
· The facility has one or more functioning carbon monoxide detectors that meet the statutory requirements CARBON MONOXIDE DETECTOR LOCATED IN DOWNSTAIRS HALLWAY
· The fireplace is properly screened YES
· The facility has adequate heating and ventilation YES
· Where children less than five years old are in care, stairs are fenced or barricaded YES
· Clean, safe and age appropriate toys YES
· Storage areas for detergents, cleaning compound, medications and other hazards which could pose a danger to children are stored where they are inaccessible to children. YES
· Poisons and toxins are stored in key-locked area and remain locked while children are in care YES
· No guns or weapons present as stated by the Licensee NONE AS OF 12/13/16. APPLICANT UNDERSTANDS ALL GUNS, WEAPONS AND AMMUNITION MUST BE KEY-LOCKED SEPARATELY AND MADE INACCESSIBLE PER TITLE 22 REGULATIONS.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2016
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 5


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: BOOKER FAMILY CHILD CARE
FACILITY NUMBER: 364814242
VISIT DATE: 12/13/2016
NARRATIVE
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AB 2621 – Health and Safety Code 1596.819. (a) Except as otherwise prohibited by law, the department shall post licensing information on its Internet Web site as follows: Section 1596.750, the information for family child care homes shall include, the licensed capacity of the facility, the status of the license, and the number of site visits, including the number of citations, substantiated and inconclusive complaint inspections, and non-complaint inspections during the preceding five-year period. The department shall update the information posted on at least a monthly basis.

During the exit interview, the Licensee, REGINA BOOKER confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

The 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, as well as any documents showing correction of Type A deficiencies. A civil penalty of $100 per violation will be assessed for noncompliance.

An exit interview was conducted, Notice of Site Visit posted, Appeal Rights discussed, and a copy of this report was provided to the licensee on this date.

As a REMINDER: when your child(ren) turns 18 years of age, you MUST submit an updated LIC279, LIC508 and TB screen and have your child get live scanned. This also applies to any adult PRIOR to them moving into the home or who currently lives in the home. Also, PRIOR to employment of ANY adult, you must submit the LIC508, TB screen and get them live scanned and cleared.

You can access our website at: www.ccld.ca.gov to obtain ANY licensing information. Please subscribe to MyCCL on our website. Department updates will be sent directly to your e-mail account once you have set up an account.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2016
LIC809 (FAS) - (06/04)
Page: 2 of 5


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: BOOKER FAMILY CHILD CARE
FACILITY NUMBER: 364814242
VISIT DATE: 12/13/2016
NARRATIVE
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SB 792 – Day Care Facilities; Immunizations - Effective September 1, 2016, in accordance with California Health & Safety Code 1597.622 - a person may not be employed or volunteer at a family child care home unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

In accordance with California Health & Safety Code 1597.54(d) – all adults in the home during the time that children are under care must have proof of a tuberculosis clearance.



· 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 Regulations went into effect
January 1, 2012 – In accordance with California Health and Safety Code Section 1596.808
Whenever milk is served, serve only low-fat (1 percent) milk or nonfat milk to children two years of age or older. Limit juice to not more than one serving per day of 100 percent juice. Serve no beverages with added sweeteners, either natural or artificial. "Beverages with added sweeteners" does not include infant formula or complete balanced nutritional products designed for children.

· AB 2386 – Carbon Monoxide Detector Regulations went into effect January 1, 2015 – In accordance with California Health and Safety Code Section 1597.543 – every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing Section 13260) of Part 2 Division 12.

· AB 1918 –Smoking prohibition on the premises of Family Child Care Homes, effective, January 1, 2015. This bans smoking tobacco in a home that is licensed as a family child Care home, and in those areas of the family child care home were children represent. This change in law was based on demonstrated negative health effects of second and “thirdhand” smoke on children. Thirdhand smoke generally refers to the residue from tobacco smoke that sticks to surfaces after the secondhand smoke has cleared.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2016
LIC809 (FAS) - (06/04)
Page: 3 of 5


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: BOOKER FAMILY CHILD CARE
FACILITY NUMBER: 364814242
VISIT DATE: 12/13/2016
NARRATIVE
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· No bodies of water NONE AS OF 12/13/16. LICENSEE UNDERSTANDS ALL BODIES OF WATER INCLUDING, PONDS, ABOVE GROUND POOLS & SPAS, IN-GROUND POOLS & SPAS, AND FOUNTAINS MUST BE PROPERLY COVERED OR FENCED PER TITLE 22 REGULATIONS. THE DEPARTMENT MUST BE NOTIFIED BEFORE AND AFTER INSTALLATION OF THE ABOVE TYPES OF BODIES OF WATER. IN ADDITION, ALL TYPES OF WATER ACTIVITY TABLES, TOYS INCLUDING PORTABLE WADING POOLS MUST BE EMPTIED IMMEDIATELY AFTER USE AND STORED IN AN UPRIGHT POSITION WHEN NOT IN USE. FAILURE TO REPORT AND NOTIFY THE DEPARTMENT WILL RESULT IN CIVIL PENALTIES.
· The home has a current roster of the children in care YES
· The home conducts fire and disaster drills at least once every six months, and documents the date and time of each drill LAST FIRE/EARTHQUAKE DRILL CONDUCTED ON 9/16/16
· Licensee documents immunizations and maintains and updates records for children in care YES
· Licensee provides the child’s parent or representative with a copy of the Family child Care Home Notification of Parents’ Rights YES
· Pediatric CPR and First Aid Card expire on RB & KB EXP 3/29/17
· Resident and/or staff records reviewed on 12/08/16 indicate that all adults who require caregiver background checks have received all required clearances or exemptions. YES

INCIDENTAL MEDICAL SERVICES PLAN. In accordance with California Health & Safety Code 1597.54(h) - The Incidental Medical Service Plan of Operation includes administering: Blood Glucose Testing, Inhaled Medicines (asthma/bronchitis), Epi-Pen, Glucagon, G-Tube, and/or carrying out Medical Orders.
A written Plan of Operation to administer any of the above medications/services to the children in care must be submitted to the Department within 30 days. Please refer to Title 22, Division 12, Chapter 3, Article 03, Regulation 102417, Plan for Providing Incidental Medical Services (PPIMS)

There are no children in care who require Incidental Medical Services (IMS) at this time. The licensee understands that before providing care to a child who requires IMS, a Plan for Providing Incidental Medical Services must be submitted and approved by the Department.

See LIC809D for cited deficiencies.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2016
LIC809 (FAS) - (06/04)
Page: 4 of 5


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: BOOKER FAMILY CHILD CARE
FACILITY NUMBER: 364814242
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/13/2017
Section Cited
H&S 1597.622
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SB 792 – Day Care Facilities; Immunizations - Effective September 1, 2016, in accordance with California Health & Safety Code 1597.622 - a person may not be employed or volunteer at a family child care home unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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LICENSEE WAS ADVISED TO PROVIDE PROOF OF PERTUSIS (TDAP), MEASLES (MMR), AND FLU VACCINATIONS WITHIN 30 DAYS FOR ALL ADULTS WHO LIVE OR WORK IN THE HOME. COPIES OF PROOF OF VACCINATIONS MUST BE RECEIVED ON OR BEFORE 1/13/17.
EMAIL: Joanne.Domingo@dss.ca.gov
TEXT PHOTO: 951-233-9356
FAX: 951-782-4985
MAIL: Riverside Child Care Regional Office, 3737 Main St, Ste 700; Riverside, CA 92501.

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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: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2016
LIC809 (FAS) - (06/04)
Page: 5 of 5