364841453-4-11-2023-09-CC-ASHA-CQT2BW-20230411171549

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364841453
Report Date: 04/11/2023
Date Signed: 04/11/2023 05:16:02 PM

Document Has Been Signed on 04/11/2023 05:16 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:	BOOKER/CHAVEZ FAMILY CHILD CARE		FACILITY NUMBER:	364841453
ADMINISTRATOR:	S.BOOKER & A.CHAVEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 728-3445
CITY:	FONTANA	STATE: CA	ZIP CODE:	92337
CAPACITY:	14	CENSUS: 11	DATE:	04/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Stacey Booker		TIME COMPLETED:	05:30 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 date and time listed, Licensing Program Analyst (LPA) Aman Sharma arrived at the facility to conduct a required annual inspection. LPA toured the facility, inside and outside. Records were reviewed, and the following was observed and/or discussed:
Normal days and hours of operation are: Monday- Friday 6:30am-6:00pm

OFF-LIMIT AREAS ARE LISTED AS FOLLOWS: On the first floor: Room, garage, office, and bedroom, and entire second floor. There is a pool outdoors which is off-limits, as well as the left side yard.

· The facility is operating within the licensed capacity and appropriate ratios

· Appropriate supervision was being provided during this inspection

· A working telephone is present and current phone number is on file

· Appropriate fire extinguisher, smoke detector and carbon monoxide detector were present and in working order during this inspection.

· The fireplace is screened off and not accessible by children.

· All hazardous items and toxins were kept in an off-limit area of the home, inaccessible to daycare children.

· No weapons are present in the home at this time. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations

· Stairs are properly barricaded to prevent access to children in care.

· Verification of control of property is on file.

· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted in prominent location of the home.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman Sharma	TELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

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 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/CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 364841453
	VISIT DATE: 04/11/2023

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

Mandated Reporter Training for licensee and assistant have been completed and expire: 07/2023

· Pediatric CPR and First Aid Card for licensees expire: 07/2023

· Health & Safety Certificate is completed and on file.

·There is an in-ground spa and pool located in the backyard of the home. The spa and pool is surrounded by a fence that meets Title 22 Regulations. Licensee tested the gate and LPA found it be in compliance. Licensee understands all bodies of water must be properly covered or fenced per Title 22 regulations. All wading pools or similar product must be emptied immediately after use and stored in an upright position.

· Clean, safe and age appropriate toys were available to the daycare children.

· Roster is current and on file.

· Documentation of fire and disaster drills are also on file – Last drill conducted on: 01/2023

· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov

· Children’s records were complete

· Licensee’s file and assistants file were reviewed and complete

· Resident and/or staff records reviewed indicate that all adults who require caregiver background checks have received all required clearances or exemptions.

· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations862@dss.ca.gov

- LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage as an additional resource at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman Sharma	TELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

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/CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 364841453
	VISIT DATE: 04/11/2023

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

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

- Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

- Go to the licensing webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.

- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200

The Licensee, Stacey Booker confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with the licensee, Stacey Booker.

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

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 805-5718
LICENSING EVALUATOR NAME: Aman Sharma	TELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5