334843261-6-1-2023-09-CC-PORS-CSDV4B-20230601160603

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334843261
Report Date: 06/01/2023
Date Signed: 06/01/2023 04:06:25 PM

Document Has Been Signed on 06/01/2023 04:06 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	AUTMAN FAMILY CHILD CARE		FACILITY NUMBER:	334843261
ADMINISTRATOR:	PEARLETTA AUTMAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 586-4675
CITY:	DESERT HOT SPRINGS	STATE: CA	ZIP CODE:	92240
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 3	DATE:	06/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:46 PM
MET WITH:	Licensee Pearletta Autman		TIME COMPLETED:	04:20 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 Analysts (LPAs) Perla Ordones and Taityana Benson arrived at the facility to conduct a required/annual inspection as part of a compliance review. LPAs were granted entrance by Licensee Pearletta Autman, LPAs toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed: At 03:11PM, Licensee Autman had to leave to pick up children but granted permission for Facility Representative Dawud Autman to sign the report in her stead. Licensee ended up returning to the facility 03:20PM and took over the inspection once again. Normal days and hours of operation are: Monday – Sunday; 05:00AM-11:00PM. OFF-LIMIT AREAS INCLUDE: Garage, Room 1, Room 2, Master bedroom, Master bedroom bathroom, pool area, and Laundry Room. The facility is operating within the licensed capacity and appropriate ratios. · Appropriate supervision provided during this inspection. · A working telephone is present and current number on file. · Appropriate fire extinguisher, smoke detector and carbon monoxide detector present and were tested by the Licensee during this inspection. · Fireplace is properly screened to prevent access by children. · All hazardous items are stored inaccessible to children in the Laundry Room. · Toxins are locked.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Perla Ordones
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

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 06/01/2023 04:06 PM - It Cannot Be Edited

Created By: Perla Ordones On 06/01/2023 at 03:15 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: AUTMAN FAMILY CHILD CARE	FACILITY NUMBER: 334843261
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as Licensee did not posess a valid EMSA approved CPR/First Aid card which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/30/2023
	Plan of Correction
1 2 3 4	Licensee agrees to obtain a valid EMSA approved CPR/First Aid card by the Plan of Correction (POC) due date of 06/30/2023. Licensee agrees to submit proof to Community Care Licensing by the POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Kimberly Williams

LICENSING EVALUATOR NAME:

Perla Ordones

LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: AUTMAN FAMILY CHILD CARE	FACILITY NUMBER: 334843261
	VISIT DATE: 06/01/2023

NARRATIVE

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· Weapons are stored according to Title 22. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations.
· Facility is a one-story home.
· Verification of control of property on file.
· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted.
· Mandated Reporter Training expired on 05/31/2023. Licensee stated she would be renewing her Mandated Reporter Training today 06/01/2023.
· Pediatric CPR and First Aid Card expires on 05/2025. LPA observed that the Licensee’s CPR card was not EMSA approved and requested that the Licensee obtain a valid EMSA approved CPR card. Licensee agreed to obtain valid EMSA training to remain in compliance.
· Health & Safety Certificate – completed on 09/16/2007.
· There is an in-ground pool, spa and waterfall present in the backyard. These water features are all properly fenced with a mesh-type fencing and the fencing contains a gate which is self-closing and self-latching at the top of the gate and the gate opens away from the pool. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some 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 wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Clean, safe and age-appropriate toys are present.
· Current roster on file.
· Documentation of fire and disaster drills on file – Last drill conducted on 05/05/2023.
· Children’s records are not complete. During record review, LPAs observed C3 to be missing the LIC9150 and Licensee confirmed there are school age children enrolled in care. LPAs brought this to the attention of Licensee who stated C3’s parent would submit the form today upon pickup.
· Employee’s records are not complete. Licensee does not have a valid EMSA approved CPR/First Aid Card. Licensee agreed to get a valid EMSA CPR training that is not conducted online.
· During the facility tour, LPAs observed a crib to have a non-tight fitting sheet on the mattress of the crib. Licensee stated she would change the sheets to be tight fitting and LPAs did not observe any children to be sleeping in the crib during this visit.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Perla Ordones
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: AUTMAN FAMILY CHILD CARE	FACILITY NUMBER: 334843261
	VISIT DATE: 06/01/2023

NARRATIVE

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· 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

· Resident and/or staff records reviewed on 05/31/2023 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 your facility at: Associations_Disassociations862@dss.ca.gov

LPAs discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

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.

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Perla Ordones
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: AUTMAN FAMILY CHILD CARE	FACILITY NUMBER: 334843261
	VISIT DATE: 06/01/2023

NARRATIVE

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at:
https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

The LICENSEE, Pearletta Autman, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

Exit interview conducted and report was reviewed with the licensee Pearletta Autman.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Perla Ordones
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

LIC809 (FAS) - (06/04)

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