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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
364808573
Report Date:
08/12/2024
Date Signed:
08/15/2024 07:58:37 AM
Document Has Been Signed on
08/15/2024 07:58 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:
WHITE FAMILY CHILD CARE
FACILITY NUMBER:
364808573
ADMINISTRATOR/
DIRECTOR:
WHITE, JACQUELINE
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(909) 899-6697
CITY:
FONTANA
STATE:
CA
ZIP CODE:
92336
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
7
CENSUS:
6
DATE:
08/12/2024
TYPE OF VISIT:
Annual/Random
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:
Jacqueline White, Licensee
TIME VISIT/
INSPECTION COMPLETED:
05:45 PM
NARRATIVE
1
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5
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7
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10
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25
On date and time listed, Licensing Program Analyst (LPAs) Taityana Benson and Aman Lama arrived at the facility to conduct a required/annual inspection as part of a compliance review. LPAs toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed:
Normal days and hours of operation are: Monday – Friday, 7:00 a.m. – 5:00 p.m.
OFF-LIMIT AREAS INCLUDE: Entire 2
nd
Floor and Office.
The facility is operating within the licensed capacity and appropriate ratios
·
Appropriate supervision provided during this inspection
·
A working telephone is present and current number on file
·
Appropriate fire extinguisher, smoke detector and carbon monoxide detector present and were tested by the Licensee during this inspection.
·
Fireplace is properly screened to prevent access by children
·
All hazardous items are not stored inaccessible to children
·
Toxins are not locked
·
Weapons are not present according Licensee, Jacqueline White. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations
·
Stairs are barricaded
·
Verification of control of property on file (Grant Deed)
·
Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted
·
Mandated Reporter Training completed on 10/24/2024 (Child Care Providers AB1207 and General)
·
Pediatric CPR and First Aid Card expires on 10/24/2024
Report On Continued On LIC809-C
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.
LIC809
(FAS) - (06/04)
Page:
1
of
11
Document Has Been Signed on
08/15/2024 07:58 AM
- It Cannot Be Edited
Created By:
Taityana Benson
On
08/12/2024
at
01:37 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:
08/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Deficiency Dismissed
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above, LPA observed kitchen shears, a apple cutter, a pizza cutter, a potato peeler, a rat tail comb, and a blender with blade, in the kitchen cabinets and/or kitchen drawers, and a operable paper shredder in the garage, which poses an immediate safety to persons in care.
POC Due Date:
08/13/2024
Plan of Correction
1
2
3
4
Licensee agrees to make the kitchen shears, apple cutter, pizza cutter, potato peeler, rat tail comb, and a blender with blade in the kitchen cabinets and kitchen drawers inaccessible to children in care. Licensee agrees to send LPA pictures of the kitchen cabinets and drawers free from the items that pose a danger to children via email by COB on 08/13/2024.
Deficiency Dismissed
Type A
Section Cited
CCR
102417(g)(4)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above, LPA observed fuel gel and lighters in the kitchen cabinets and drawers, sunscreen in the kitchen on the shelf behind the barn sliding door, hand sanitizer on the desk in the garage, detergent pods in the laundry room in a unlocked canister, on the shelf, which poses an immediate safety to persons in care.
POC Due Date:
08/13/2024
Plan of Correction
1
2
3
4
Licensee agrees to lock the fuel gel, lighters, sunscreen, hand sanitizer, and detergent pods to make them inaccessible to children in care. Licensee agrees to send LPA pictures of the fuel gel, lighters, sunscreen, hand sanitizer, and detergent pods locked and inaccessible to children in care by COB on 08/13/2024.
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:
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
LIC809
(FAS) - (06/04)
Page:
2
of
11
Document Has Been Signed on
08/15/2024 07:58 AM
- It Cannot Be Edited
Created By:
Taityana Benson
On
08/12/2024
at
01:37 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:
08/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Deficiency Dismissed
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above, S3 Mandated Reporter Training - Child Care Providers (AB1207) is not on file and not available to view during this visit, which poses a potential safety risk to persons in care.
POC Due Date:
08/26/2024
Plan of Correction
1
2
3
4
Licensee agrees to have S3 complete the Mandated Reporter Training - Child Care Providers (AB1207) and provide proof of completion to LPA via email by COB 08/26/2024.
www.mandatedreporterca.com
Request Denied
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above, S1 and S3 immunization records are not on file and not available to view during this visit, which poses a potential health, risk to persons in care.
POC Due Date:
08/26/2024
Plan of Correction
1
2
3
4
Licensee agrees to obtain immunization records for S1 and S3 and provide LPA with a copy of S1 and S3 immunization records via email by COB on 08/26/2024.
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:
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
LIC809
(FAS) - (06/04)
Page:
3
of
11
Document Has Been Signed on
08/15/2024 07:58 AM
- It Cannot Be Edited
Created By:
Taityana Benson
On
08/12/2024
at
01:37 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:
08/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review], the licensee did not comply with the section cited above, C6 Identification and Emergency Information (LIC700), is not on file and available to view during this visit, which poses a potential safety risk to persons in care.
POC Due Date:
08/26/2024
Plan of Correction
1
2
3
4
Licensee agrees to obtain a completed and signed Identification and Emergency Information (LIC700) for C6 and provide a copy to LPA via email by COB on 08/26/2024.
Request Denied
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above, the facility roster is incomplete, with the licensee's own omission, there is 7 children enrolled, the facility roster list 17 children enrolled, which poses a potential safety risk to persons in care.
POC Due Date:
08/26/2024
Plan of Correction
1
2
3
4
Licensee agrees to update the facility roster to make the facility roster current and complete. Licensee agrees to send a picture of the completed facility roster to LPA via email by COB on 08/26/2024.
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:
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
LIC809
(FAS) - (06/04)
Page:
4
of
11
Document Has Been Signed on
08/15/2024 07:58 AM
- It Cannot Be Edited
Created By:
Taityana Benson
On
08/12/2024
at
01:37 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:
08/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Deficiency Dismissed
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above, the Notification of Parent's Rights (LIC995A) is not on file and not available to view during this visit, which poses a potential personal rights risk to persons in care.
POC Due Date:
08/26/2024
Plan of Correction
1
2
3
4
Licensee agrees to obtain a completed and signed Notification of Parent's Rights (LIC995A) for C2 and maintain the LIC955A in C3's facility file. Licensee agrees to provide LPA with a copy of the signed bottom portion of the LIC995A for C3 via email by COB 08/26/2024.
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:
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
LIC809
(FAS) - (06/04)
Page:
5
of
11
Document Has Been Signed on
08/15/2024 07:58 AM
- It Cannot Be Edited
Created By:
Taityana Benson
On
08/12/2024
at
01:37 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:
08/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
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: Time of each 15-minute check
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above. With licensee's own omission, C3 does not have a physical Infant Sleep Log available for review during the visit which poses a potential safety risk to persons in care.
POC Due Date:
08/26/2024
Plan of Correction
1
2
3
4
Licensee agrees to create an Infant Sleep Log for C3 that documents the date, infant’s name, and time of each 15-minute check, initials and provide a copy to LPA via email by COB 08/26/2024.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
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
LIC809
(FAS) - (06/04)
Page:
6
of
11
Document Has Been Signed on
08/15/2024 07:58 AM
- It Cannot Be Edited
Created By:
Taityana Benson
On
08/12/2024
at
02:37 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:
08/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type B
Section Cited
CCR
10239(b)(9)
Application for Initial License
Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above, S2 and S3 tuberculosis (TB) clearance is not on file or available to view during this visit, which poses a potential health risk to persons in care.
POC Due Date:
08/26/2024
Plan of Correction
1
2
3
4
Licensee agrees to obtain proof of tuberculosis (TB) clearance for S2 and S3 and provide a copy to LPA via email by COB on 08/26/2024.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
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
LIC809
(FAS) - (06/04)
Page:
7
of
11
Document Has Been Signed on
08/15/2024 07:58 AM
- It Cannot Be Edited
Created By:
Taityana Benson
On
08/12/2024
at
02:50 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:
08/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type A
Section Cited
HSC
1596.8595(c)(1)
1596.8595Posting licensing report by child care facility or home; duration of posting; civil penalty for failure to comply; reports to be provided to parents or guardian of each child receiving services.
(c)(1) A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above, a signed Acknowledgement of Receipt of Licensing Report (LIC9224) for report dated 05/29/2024 is not on file or available to view during this visit for C3, C5, and C6, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
08/13/2024
Plan of Correction
1
2
3
4
Licensee agrees to provide the report dated 05/29/2024 that documents a Type A citation to the parents of C3, C5 and C6. Licensee agrees to obtain a signed and completed Acknowledgement of Receipt of Licensing Report (LIC9224) for report dated 05/29/2024 for C3, C5, and C6 and provide a copy to LPA via email by COB on 08/13/2024.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
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
LIC809
(FAS) - (06/04)
Page:
8
of
11
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:
08/12/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
·
Health & Safety Certificate – completion date previously confirmed as completed.
·
There is a in ground pool and spa located in the backyard. The pool and spa are enclosed with a 5 ft wrought iron fence. The gate was tested by the licensee at time of visit and the gate is a self-closing, self-latching, and swings away from the pool and spa. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
·
Clean, safe and age appropriate toys
·
Current roster not on file
·
Documentation of fire and disaster drills on file – Last drill conducted on 07/05/2024
·
Children’s records are not complete
·
Employee’s records are not complete
·
The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox:
UnusualIncidentReportsDO09@dss.ca.gov
·
Resident and/or staff records reviewed on 08/12/2024 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.
·
The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at:
Associations_Disassociations862@dss.ca.gov
- LPA discussed the safe sleep regulations with Licensee, Jacqueline White 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. LPA also informed licensee [or facility representative] 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.
- LPA also informed Licensee, Jacqueline White 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
Report On Continued On LIC809-C
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
LIC809
(FAS) - (06/04)
Page:
9
of
11
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:
08/12/2024
NARRATIVE
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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)/ (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/
.
- Licensee, Jacqueline White was 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 5 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.
- 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.
- Licensee, Jacqueline White was informed of the MyChildCarePlan.org website; 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.
- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:951-782-4200
See LIC809-D for cited deficiencies.
LPA
Taityana Benson
informed
Licensee, Jacqueline White
that
this report dated
08/12/2024
document(s)
3
Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Report On Continued On LIC809-C
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
LIC809
(FAS) - (06/04)
Page:
10
of
11
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:
08/12/2024
NARRATIVE
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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.
Also, LPA
Taityana Benson
informed the informed
Licensee, Jacqueline White
to provide a copy of this licensing report dated
08/12/2024
that documents any Type A citation(s) to parents/guardians 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 (LIC 9224), or other written statement, must be placed in the child's file for verification.
During the exit interview, Licensee, Jacqueline White confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
Exit interview conducted and report was reviewed with the Licensee, Jacqueline White.
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
LIC809
(FAS) - (06/04)
Page:
11
of
11