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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300653
Report Date: 03/07/2024
Date Signed: 03/07/2024 11:54:52 AM

Document Has Been Signed on 03/07/2024 11:54 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 SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
336300653
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 11CENSUS: 6DATE:
03/07/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:14 AM
MET WITH:Rosaura JimenezTIME COMPLETED:
12:04 PM
NARRATIVE
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On 3/7/2024 at 10:14am, Licensing Program Analysts (LPAs) Jeanette Sanchez and Gabriela Hernandez arrived at the facility to conduct a case management inspection as part of a compliance plan. LPAs met with Licensee Rosaura Jimenez.

LPAs toured facility, took census and reviewed records. LPAs were informed that two children in care had just started today. One child has a previous file from previous enrollment but the other child does not have a file. Neither child is on the roster.

LPAs found toothpaste on the bathroom counter which has a safety label of keep out of reach of children and contact Poison Control. Children were being supervised in the living room at the time of arrival and inspection. LPAs consulted with licensee to always be aware of safety labels on products. Licensee removed items during inspection.

See LIC809-D for cited deficiencies

An exit interview was conducted, and this report was reviewed with the licensee Rosaura Jimenez. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jeanette Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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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Document Has Been Signed on 03/07/2024 11:54 AM - It Cannot Be Edited


Created By: Jeanette Sanchez On 03/07/2024 at 10:51 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 336300653

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/15/2024
Section Cited
CCR
102421(b)

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102421 Child's Records (b) The licensee shall maintain, in each child's record, a copy of the emergency information card...This requirement was not met as evidenced by:
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Licensee will provide copies of files to LPA by 3/15/2024.
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C1 does not have any required forms. C2 only has forms from previous enrollment. This poses a potential health, safety or personal rights risk to persons in care.
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Type B
03/15/2024
Section Cited
CCR102417(g)(8)

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102417 Operation of a Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child...(8) Each family child care home shall have a current roster of children...This requirement was not met as evidenced by:
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Licensee will provide updated roster to LPA by 3/15/2024.
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Roster is missing C1 and C2. This poses a potential health, safety or personal rights risk to persons in care.
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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:Deborah Mullen
LICENSING EVALUATOR NAME:Jeanette Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 03/07/2024 11:54 AM - It Cannot Be Edited


Created By: Jeanette Sanchez On 03/07/2024 at 11:37 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 336300653

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/15/2024
Section Cited
CCR
102417(g)(4)

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(g) The home shall be free from defects or conditions which might endanger a child...(4) Poisons...and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement was not met as evidenced by:
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Licensee removed during inspection
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Toothpaste which has a safety label of keep out of reach of children and contact Poison Control was found on the bathroom counter. This poses a potential health, safety or personal rights risk to persons in care.
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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:Deborah Mullen
LICENSING EVALUATOR NAME:Jeanette Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024


LIC809 (FAS) - (06/04)
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