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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364808573
Report Date: 05/29/2024
Date Signed: 05/29/2024 04:56:39 PM

Document Has Been Signed on 05/29/2024 04:56 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:WHITE FAMILY CHILD CAREFACILITY NUMBER:
364808573
ADMINISTRATOR/
DIRECTOR:		WHITE, JACQUELINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 899-6697
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
05/29/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Ashley Haire, AssistantTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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On date and time listed, Licensing Program Analyst (LPA) Taityana Benson arrived at the facility to initiate an investigation in a separate matter. LPA Benson was greeted by Assistant, Ashley Haire, whom stated the Licensee was not present at facility and was set to return to the facility tomorrow. The following was observed and discussed:

At the time of arrival, LPA Benson toured the facility and took census, there was 1 adult assistant present alone, providing care and supervision in the garage to 11 children in care. At 8:57 a.m, LPA Benson observed an additional child arrive whom joined the existing children in the garage with the only present assistant. At that time, LPA Benson took another census and confirmed the census was 12 children and 1 adult assistant. The assistant provided LPA Benson with all children in care records present at the time of the visit. The facility is not operating within the licensed capacity and appropriate ratios, there were 2 infants, 9 preschool age children, and 1 school age child. The facility is reminded at a Large Family Child Care Home, the licensee shall comply with capacity requirements for a Small Family Child Care Home when there is one adult present providing care and supervision.

LPA Taityana Benson informed 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.

See LIC809-D for cited deficiencies.

A notice of site visit was given 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.

Report Continued on LIC809-C
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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 05/29/2024 04:56 PM - It Cannot Be Edited


Created By: Taityana Benson On 05/29/2024 at 03:51 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 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
102416.5(e)

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If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in...(b) and (c).
This requirement is not met as evidenced by:
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Licensee agrees to write a letter of understanding of regulation Staffing Ratio and Capacity 1102416.5(e). Licensee agrees to establish a schedule. Licensee agrees to provide a copy of the schedule to LPA via email by COB 05/30/2024.
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Based on observation and record review, the licensee did not comply with the section cited above. During the visit, the census is 12 children, 2 infants, 9 preschool age children, and 1 school age child, which poses an immediate health, 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.
SUPERVISOR'S NAME:Ana Noble
LICENSING EVALUATOR NAME:Taityana Benson
LICENSING EVALUATOR SIGNATURE:
DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2024


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: WHITE FAMILY CHILD CARE
FACILITY NUMBER: 364808573
VISIT DATE: 05/29/2024
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Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Also, LPA Taityana Benson informed Assistant, Ashley Haire to provide a copy of this licensing report dated 05/29/2024 that documents any Type A citations 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, and the report was reviewed with the Assistant, Ashley Haire.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC809 (FAS) - (06/04)
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