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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846201
Report Date: 06/16/2023
Date Signed: 06/16/2023 11:47:40 AM

Document Has Been Signed on 06/16/2023 11:47 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:DAVIS FAMILY CHILD CAREFACILITY NUMBER:
334846201
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/16/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Sarah DavisTIME COMPLETED:
12:03 PM
NARRATIVE
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On 6/16/23, at 11:10 am, an informal meeting was held at the Riverside Regional Child Care Office. Present in the meeting was Licensee Sarah Davis, Licensing Program Manager (LPM) Aaron Ross, Licensing Program Analysts (LPAs) Raymond Moorehead and Patricia Berry.

The Purpose of the meeting is to review and discuss:
Over Capacity
Pending Complaint
Pending Capacity Increase

LPM and LPAs reviewed the pending complaint findings with licensee.

Facility's compliance history was reviewed during the meeting. During the meeting, LPM and LPA’s introduced the Child Care Technical Support Program (TSP) stating TSP is a voluntarily program to assist facilities with meeting and maintaining the requirements of operating a licensed childcare facility.

Licensee stated she would notify her LPA if she would like to contact TSP and Impact.

Licensee and staff was advised to review Child Care Provider videos related to “Operation of a Family Childcare Program”. SEE Videos: https://ccld.childcarevideos.org/family-child-care-providers/



Continued on 809-C.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2023
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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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: DAVIS FAMILY CHILD CARE
FACILITY NUMBER: 334846201
VISIT DATE: 06/16/2023
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 Licensee was granted her request for a capacity increase licensee effective today’s date.

As a result of this informal conference, Licensee Sarah Davis understands the department’s expectations and agrees to maintain substantial compliance with Title 22 Regulations. Also, a citation for Reporting Requirement, is being issued.

During the course of the complaint investigation, LPAs discovered that the licensee did not report the communicable disease to Community Care Licensing. Licensee stated that she had 2 cases of pink eye, which is considered an outbreak. According to regulation 102416.2 Reporting Requirements (c) In addition to the events specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C), the licensee shall report the following events to the Department: (3) A communicable disease outbreak when determined by the local health authority. Based on information received, the facility will be cited for failure to report.

See LIC809-D for cited deficiency.




Exit interview conducted with license reports, appeal rights and notice of site visit provided to licensee.

Notice of Site visit must be posted for 30 days.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/16/2023 11:47 AM - It Cannot Be Edited


Created By: Raymond Moorehead On 06/16/2023 at 09:58 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: DAVIS FAMILY CHILD CARE
FACILITY NUMBER: 334846201

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/20/2023
Section Cited
CCR
102416.2(c)(3)

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Reporting Requirements (c)... the licensee shall report the following events to the Department: (3) A communicable disease outbreak when determined by the local health authority.
This requirement was not met as evidence by
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Licensee stated that she will send in a Unusual Incident Report regarding the communicable disease outbreak.
Licensee stated that she will send a written statement on acknowledgement, understanding, and compliance to the regulations cited.
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Based on the complaint investigation, LPAs discovered that the licensee did not report the communicable disease to community care licensing in the required time frame.
This is a potential risk to the health and safety to the children in care.
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Licensee will send the Unusual Incident Report and the written statement to Community Care Licening by 06/20/2023.

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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:Raymond Moorehead
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2023


LIC809 (FAS) - (06/04)
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