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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845058
Report Date: 08/18/2022
Date Signed: 08/18/2022 01:01:24 PM

Document Has Been Signed on 08/18/2022 01:01 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:HARUN FAMILY CHILD CAREFACILITY NUMBER:
334845058
ADMINISTRATOR:HARUN,MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 215-2249
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY: 14TOTAL ENROLLED CHILDREN: 15CENSUS: 12DATE:
08/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Licensee Maria HarunTIME COMPLETED:
01:10 PM
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On 08/18/2022 at 8:00 AM Licensing Program Analyst (LPA) Susan Brewer, arrived at the facility to conduct an annual inspection. LPA was greeted by Staff 1 and 2, who stated that the licensee was away from the facility. and granted entry to tour the facility, inside and out. LPA reviewed records and observed and/or discussed the following: Present were the Staff 1-Giselle Martinez and Staff 2 a minor/resident. The Licensee Maria Harun, was notified of the inspection and arrived at approximately 8:25 AM. Documents reviewed with the licensee M. Harun were updates and changes to the LIC279 Application form, LIC610A Emergency Disaster Plan-relocation sites, 999A Home Sketch for 1st and 2nd Floors and Yard sketch. The licensee stated that once the updates are completed the forms will be submitted to community care licensing with the changes.

Normal days & hours of operation: Mon. – Thu. 7:00 AM to 4:30 PM; Fri. 7:00 AM to 3:00 PM

OFF-LIMIT AREAS INCLUDE: 1st Floor Living Room, Restroom and closet next to stairs, Kitchen, Bedroom #6, Entire 2nd Floor and Garage; The backyard is temporarily off-limits due to plans for landscaping.

The inspection consisted of reviews of the following domain: Physical Plant, Care and Supervision, Records, Facility Administration, Staffing Ratio and Capacity, Personal Rights. The inspection found the facility to be in compliance in these domains, except as noted on the LIC809D.

· The facility is operating within the licensed capacity and appropriate ratios. A census of 11 children
· While the Licensee Maria Harun, was not present in the home and has ensured that children in care are supervised and arranged for a substitute adult and additional staff to care for and supervise children.
· A working telephone is present on 08/18/2022.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2022
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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: HARUN FAMILY CHILD CARE
FACILITY NUMBER: 334845058
VISIT DATE: 08/18/2022
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· Appropriate fire extinguisher x 2 and in the green, smoke detector and carbon monoxide detector are present and were tested by the Licensee Maria Harun, during this inspection on 08/18/2022.
· All hazardous items are inaccessible, this includes detergents, cleaning compounds, medications and other items which could pose a danger to children on 08/18/2022.
· Storage of poisons is inaccessible to children and locked on 08/18/2022.
· There is a properly barricaded fireplace on 08/18/2022.
· No guns or weapons present as stated by the Licensee. Licensee Maria Harun, understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations.
· Stairs are barricaded on 08/18/2022.
· Home is clean and orderly, with heating and ventilation for safety and comfort on 08/18/2022.
· Safe and appropriate toys and equipment are present for both indoor and outdoor activities.
· Outdoor play areas are fenced and appropriate supervision is present on 08/18/2022.
· Verification of control of property on file by grand deed of trust dated 05/18/2018.
· Pediatric CPR and First Aid Card expire on 07/2024.
· Health & Safety Certificate - completed on 06/10/2018.
· Mandated reporter General: NOT ON FILE; AB1207 Child Care Expires: 07/2024
· Fire clearance: 08/26/2018
· Documentation of fire & earthquake drills to be conducted every six months: Last drill on 07/22/2022; at 9:15 AM and lasted 15 minutes, with
· There are no bodies of water on 08/18/2022. 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.
· Children’s files are NOT complete: Present 08/18/2022 and identified on confidential names list.
1. Child 1- Infant 3.5 months old, missing LIC9227 Infant Safe Sleep Plan
2. Child 2- Infant 22 months old, missing sleep logs.
3. Child 3-Infant 7 months old, missing LIC 9227 Infant Safe Sleep Plan
4. Child 4- Infant 18 months old, Missing sleep logs.
· Staff’s files are complete on 08/18/2022.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022
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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: HARUN FAMILY CHILD CARE
FACILITY NUMBER: 334845058
VISIT DATE: 08/18/2022
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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.

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 Maria Harun, 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.

LPA Susan Brewer, discussed the safe sleep regulations with licensee Maria Harun 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 re-called 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.

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.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022
LIC809 (FAS) - (06/04)
Page: 3 of 8
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: HARUN FAMILY CHILD CARE
FACILITY NUMBER: 334845058
VISIT DATE: 08/18/2022
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See LIC809D for Type B Deficiency cited this visit 08/18/2022.

No civil penalties cited.

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

Exit interview conducted by LPA Susan Brewer, the evaluation report was reviewed and left with the licensee Maria Harun.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/18/2022 01:01 PM - It Cannot Be Edited


Created By: Susan Brewer On 08/18/2022 at 12:11 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: HARUN FAMILY CHILD CARE
FACILITY NUMBER: 334845058

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on 08/18/2022 LPA Susan Brewer, record review, the licensee Maria Harun did not comply with the section cited above in failing to obtain the LIC9227 Infant Safe Sleep Plans for Child 1- Infant 3.5 months old and Child 3-Infant 7 months old, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/19/2022
Plan of Correction
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The licensee Maria Harun, agrees to obtain LIC9227 Infant Safe Sleep Plans for Child 1 and Child 3, and submit proof of documentation, along with a written statement of understanding the cited regulation to the department by fax or e-mail on or before 08/19/2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Pauline Beschorner
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2022


LIC809 (FAS) - (06/04)
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