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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364808573
Report Date: 05/29/2024
Date Signed: 08/12/2024 05:43:48 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/20/2024 and conducted by Evaluator Taityana Benson
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20240520163658
FACILITY NAME:WHITE FAMILY CHILD CAREFACILITY NUMBER:
364808573
ADMINISTRATOR:WHITE, JACQUELINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 899-6697
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY:14CENSUS: 12DATE:
05/29/2024
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Ashley Haire, AssistantTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Criminal Record Clearance

INVESTIGATION FINDINGS:
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***This is an amended report, the original report is dated 05/29/2024***
Licensing Program Analyst (LPA) Taityana Benson arrived at the facility to conduct an inspection for the purpose of a complaint investigation, regarding the above allegation. Upon arrival at the facility, LPA Benson was greeted by Assistant, Ashley Haire, whom stated the Licensee was not present at facility. The following was observed and discussed with Assistant, Ashley Haire:

Per interviews conducted, and information gathered, the investigation revealed the Licensee, Jacqueline White allowed an adult to reside in the home without first obtaining a criminal record clearance. The uncleared adult was observed by LPA Benson at the time of the visit, during the physical inspection of the facility. It was disclosed that the uncleared adult has been residing in the home for at least nine months.

Report Continued On LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 09-CC-20240520163658
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: WHITE FAMILY CHILD CARE
FACILITY NUMBER: 364808573
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
05/30/2024
Section Cited
CCR
102370(d)(1)
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***This is an amended report, the original report is dated 05/29/2024***
102370(d)(1) All individuals subject to a criminal record review....shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption
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Licensee agrees that both uncleared adults will not return to the facility until they have a criminal record clearance. Licensee agrees to provide proof of a completed LIC9163 for each adult to LPA by 05/30/24 via email. A civil penalty of $100.00 per day, per adult, is assessed, totalling $1,000.00.
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as required by the Department. This requirement is not met as evidenced by: Based on LPA observation, licensee omission, and record review, the licensee did not comply with the section cited above. Beginning November 2023, the licensee allowed one adult to reside in the home, and
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an additional adult to work in the home, without first obtaining a criminal record clearance for each adult, which poses an immediate safety 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.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 09-CC-20240520163658
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: WHITE FAMILY CHILD CARE
FACILITY NUMBER: 364808573
VISIT DATE: 05/29/2024
NARRATIVE
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***This is an amended report, the original report is dated 05/29/2024***
Per interviews conducted, and information gathered, the investigation revealed the Licensee, Jacqueline White allowed an adult to work at the facility without first obtaining a criminal record clearance. The uncleared adult was observed by LPA Benson at the time of the visit, during the physical inspection of the facility. It was disclosed that the uncleared adult has been working at the facility for several years. Licensee stated she ensured the person was clear and associated to the facility and she never requested to disassociate the individual. LPA informed the Licensee the Regional Office received a request to disassociate the adult staff member on 07/17/2020.LPA Benson reminded the facility staff that prior to an adult (18 years of age and older) working, residing, or volunteering in a licensed facility, they must have a criminal record clearance or a criminal record exemption as required by the Department, and be associated to the facility.

Based on interviews with pertinent parties and records obtained throughout the investigation, the department has determined the preponderance of evidence standard has been met, therefore the allegation of Criminal Record Clearance is found to be SUBSTANTIATED. See LIC9099-D for deficiency cited per California Code of Regulations Title 22, Division 12. A Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

LPA Benson informed the Assistant, Ashley Haire that this report dated 05/29/2024 documents (1) Type A citation(s) which shall be posted for 30 consecutive days as there was an immediate risk to the Health, Safety, or Personal Rights of children in care. A signed Acknowledgement of Receipt of Licensing Report (LIC9224) was provided to facility during this inspection. The LIC9224 Type A citation must be provided to parents/guardian of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC9224), or other written statement, must be placed in the child's file for the verification.

An exit interview was conducted with Assistant, Ashley Haire and appeals rights were discussed. LPA provided Assistant, Ashley Haire with a copy of this report, Civil Penalty, Appeal Rights, and Notice of Site Visit. A Notice of Site Visit 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.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2024
LIC9099 (FAS) - (06/04)
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