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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845902
Report Date: 02/09/2024
Date Signed: 02/09/2024 10:53:15 AM

Document Has Been Signed on 02/09/2024 10:53 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:BOLDEN FAMILY CHILD CAREFACILITY NUMBER:
334845902
ADMINISTRATOR:ANGELA & LAKEISHA BOLDENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 957-5028
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
02/09/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Lakeisha and Angela BoldenTIME COMPLETED:
11:15 AM
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On 02/09/2024 at 8:45 AM, Licensing Program Analysts (LPAs) Tiffanie Diep and Elyse Jones met with Licensees Lakeisha and Angela Bolden for the purpose of an unannounced annual inspection. Entrance Checklist (LIC 126) was provided to Licensees, and Licensees guided LPAs on a tour of the home. LPAs observed three children present in the home with Licensees and a non-client adult resident. Licensees’ operating hours are Monday through Friday from 6:30 AM to 6:00 PM. LPAs verified that annual fees are current.

All individuals subject to a criminal record review have obtained a criminal record clearance. Licensees were reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of five days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPAs reviewed all three children's files, and LPAs observed emergency information and required immunization records were on file. LPAs observed a current roster and documentation that a fire drill is conducted at least once every six months. LPAs verified Licensees’ immunization records were available in the facility file. Current Mandated Reporter Training certificates for Licensees were verified and expires on 01/21/2026. Current EMSA pediatric CPR and first aid certifications were verified and expires on 08/2024 for Licensee Lakeisha Bolden and on 07/2024 for co-Licensee Angela Bolden.

Continues on 809-C
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: BOLDEN FAMILY CHILD CARE
FACILITY NUMBER: 334845902
VISIT DATE: 02/09/2024
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Continued from 809 (Page 2)

A health and safety inspection of the home’s interior and exterior was conducted in all areas accessible to children. The off-limits areas in the home include the kitchen, bedroom, storage closet, and garage on first floor, and entire second floor. Licensees acknowledged that children may never enter the off-limits areas. LPAs observed stairs to the second floor barricaded by a baby gate. LPAs observed the required postings and a working phone. LPAs observed a 2A10BC fire extinguisher meets regulations and verified dual smoke and carbon monoxide detectors were functional. LPAs observed a restroom and verified that toxic and hazardous items were inaccessible to children in care. LPAs observed cleaners stored underneath the bathroom sink and inaccessible to children in care. LPAs observed the family room with age-appropriate toys for children. Licensees stated there are no weapons in the home. LPAs did not observe a fireplace in the home. The outdoor play area was inspected and is surrounded by a wooden fence and brick wall. LPAs walked the perimeter of the outdoor play area during inspection and verified that the entire area is fenced in. LPAs did not observe bodies of water on the premises.

LPAs discussed the safe sleep regulations with Licensees 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. LPAs also informed Licensees 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. LPAs discussed the requirement to check and log infant sleeping every 15 minutes for infants under 24 months and to maintain all sleeping logs at the facility for review.

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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at https://www.ada.gov/resources/child-care-centers/.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: BOLDEN FAMILY CHILD CARE
FACILITY NUMBER: 334845902
VISIT DATE: 02/09/2024
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Continued from 809-C (Page 3)

To improve the quality and value of the new inspection process, a survey may be sent to the e-mail address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE Tool, please send e-mail inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. Licensees were informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Because Licensees rent/lease the home, proof of landlord notification is required. LPAs observed the Property Owner/Landlord Notification form (LIC 9151) that Licensees confirm was provided to the property owner/landlord. Licensees obtained a signed Property Owner/Landlord Consent Form (LIC 9149).

Based on LPAs’ observations, interviews conducted, and records reviewed, a deficiency is being cited on the attached LIC 809-D. LPAs Tiffanie Diep and Elyse Jones informed the licensees, Angela and Lakeisha Bolden, that this report dated 02/09/2024 documents one Type B citation as there was a potential risk to the health, safety, or personal rights of children in care.

An exit interview was conducted and report was reviewed with the licensees, Lakeisha and Angela Bolden. During the exit interview, Licensees confirmed that there are no registered sex offenders (RSO) living in the facility and LPAs completed the RSO profile in the Field Automation System. A notice of site visit was given to Licensees 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.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/09/2024 10:53 AM - It Cannot Be Edited


Created By: Tiffanie Diep On 02/09/2024 at 10:05 AM
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: BOLDEN FAMILY CHILD CARE
FACILITY NUMBER: 334845902

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, interviews conducted, and records reviewed, the licensees did not comply with the section cited above as licensees did not ensure 15-minute sleeping logs were maintained for one of one child which poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 02/15/2024
Plan of Correction
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LPAs discussed the requirement to check and log infant sleeping every 15 minutes for infants under 24 months and to maintain all sleeping logs at the facility for review. Licensees agreed to provide LPAs with a completed 15-minute sleeping log for C1 by 02/15/2024.
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:Aaron Ross
LICENSING EVALUATOR NAME:Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2024


LIC809 (FAS) - (06/04)
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