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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334814522
Report Date: 06/29/2023
Date Signed: 06/29/2023 03:35:38 PM

Document Has Been Signed on 06/29/2023 03:35 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MOORE FAMILY CHILD CAREFACILITY NUMBER:
334814522
ADMINISTRATOR:MOORE, LAKEYCHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
9514881074
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
06/29/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Lakeycha MooreTIME COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Sumayya Habeebulla and Ana Noble conducted a case management visit to inspect the above ground pool that was recently installed at the facility to ensure it has been removed. Present during this visit was Licensee Ms. Lakeycha Moore.

During the annual visit conducted on 06/22/23, LPA Habeebulla observed that the Licensee had installed an above ground pool at the facility and had not placed any fencing or cover for the pool as required, per Title 22 Regulations. During visit, the Licensee informed LPA that the facility was closed for the summer and would not reopen until August 11th, 2023; however, the Licensee did not communicate this information to the department. LPA obtained a written statement from the Licensee that the facility would remain closed and was subsequently placed on Inactive Status since she did not have any children in care.

On 06/23/23, LPA received a phone call from Licensee requesting to go back on active status and stated that she would be draining the pool and would then pack it away.

LPA confirmed that the Licensee provided care to children while the above ground pool was in the backyard. Therefore, LPA will be issuing civil penalties.

See LIC 809D for deficiency cited.

An exit interview was conducted, and this report was reviewed with the licensee, Lakeycha Moore. Appeal rights were discussed and provided during the exit interview. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2023
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 10/03/2023 11:13 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 10/02/2023 02:30 PM


Created By: Sumayya Habeebulla On 06/29/2023 at 03:00 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MOORE FAMILY CHILD CARE
FACILITY NUMBER: 334814522

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
06/30/2023
Section Cited
CCR
102417(g)(5)(A)(B)

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(5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground),fixed-in-place wading pools, hot tubs, spas, fishponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.
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Licensee has removed the pool from the backyard and was observed to be removed by LPA Habeebula and Noble..
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Based on observation, and interview, the licensee did not comply with the section cited above in making the above ground pool present in the backyard inaccessible to childcare children which poses an immediate health, safety, or personal rights risk to persons in care.
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This is an amended report.

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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:Carlos Martinez
LICENSING EVALUATOR NAME:Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2023


LIC809 (FAS) - (06/04)
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