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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364808870
Report Date: 12/20/2024
Date Signed: 12/20/2024 04:02:07 PM

Document Has Been Signed on 12/20/2024 04:02 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:JANISZEWSKA FAMILY CHILD CAREFACILITY NUMBER:
364808870
ADMINISTRATOR/
DIRECTOR:		CZESLAWA JANISZEWSKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 874-7322
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 4DATE:
12/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Czeslawa JaniszewskaTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 12/20/2024 at 12:15 PM, Licensing Program Analyst (LPA) Tiffanie Diep and Office Assistant (OA) Christopher Escalera arrived at the facility to conduct an annual inspection. LPA toured inside and outside of the home, reviewed records, and observed and/or discussed the following:
  • Licensee Czeslawa Janiszewska’s adult child (C5) was also present during the inspection.
  • Normal days and hours of operation are Monday through Friday from 6:00 AM to 6:00 PM.
  • Per Licensee’s request, the off-limits areas will now include: the entire second floor, den, and garage.
  • The facility was operating within the licensed capacity and appropriate ratios.
  • Appropriate supervision was provided during the inspection.
  • A working telephone was present with current number on file.
  • An appropriate fire extinguisher was present (3A40BC). A functioning dual smoke detector and carbon monoxide detector were present and tested by Licensee during the inspection.
  • Fireplace was properly screened by furniture to prevent access by children in care.
  • All hazardous items were not stored inaccessible to children. LPA observed two bottles of insect repellent on a cabinet, a knife in a kitchen drawer that was not secured, and multiple knives in a drying rack by the kitchen sink. Licensee placed the items in areas inaccessible to children during the visit.
  • Toxins were locked.
  • There are no weapons present in the home per Licensee. Licensee understands all firearms, weapons, and ammunition must be locked separately and made inaccessible to children in care according to Title 22 Regulations.
  • Stairs were barricaded by a baby gate.
  • Verification of control of property on file (Property Tax Bill).

Continues on LIC 809-C
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: JANISZEWSKA FAMILY CHILD CARE
FACILITY NUMBER: 364808870
VISIT DATE: 12/20/2024
NARRATIVE
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Continued from LIC 809 (Page 2)
  • Facility sketches, Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), and Notification of Parents' Rights poster (PUB 394) were posted.
  • Pediatric CPR and first aid certification expires on 07/01/2025.
  • Mandated Reporter Training certificate expires on 06/02/2025.
  • Licensee confirmed there are no accessible bodies of water on the premises at this time. Licensee understands all bodies of water, including in-ground and above-ground pools, hot tubs, spas, and ponds, must be inaccessible to children in care and be properly covered or fenced according to Title 22 Regulations. The Department must be notified prior to installation of these and similar bodies of water.
  • Clean, safe, and age-appropriate toys were present in the living room.
  • A current roster of children was on file.
  • Documentation of fire and disaster drills was on file; last drill was conducted on 11/29/2024.
  • Children’s records were complete.
  • Staff records were not complete. LPA did not observe required immunizations for Licensee. LPA reminded Licensee to maintain documentation of the required immunizations for all employees and volunteers.
  • Licensee was informed of their reporting requirements and was provided with the Regional Office’s Unusual Incident Reporting e-mail at UnusualIncidentReportsDO09@dss.ca.gov.
  • Licensee can submit transfer forms to associate new individuals or to disassociate someone from their facility via e-mail to Associations_Disassociations862@dss.ca.gov.
  • The Duty Officer is available to answer questions Monday through Friday from 8:00 AM to 5:00 PM at (951) 782-4200.
  • Resident and/or staff records reviewed during today’s inspection indicate that all adults who require caregiver background checks have received all required clearances or exemptions.

Licensee 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 five 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.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
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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: JANISZEWSKA FAMILY CHILD CARE
FACILITY NUMBER: 364808870
VISIT DATE: 12/20/2024
NARRATIVE
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Continued from LIC 809-C (Page 3)

LPA discussed the safe sleep regulations with Licensee 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 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.

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) or (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/.

To improve the quality and value of the new inspection process, a survey may be sent to the e-mail address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE Tool, please send e-mail inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. Licensee was informed of the MyChildCarePlan.org site, 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.

Based on LPA’s observations, interview conducted, and records reviewed, deficiencies are being cited on the attached LIC 809-D. LPA Tiffanie Diep informed the licensee, Czeslawa Janiszewska, that this report dated 12/20/2024 documents one Type A citation which shall be posted for 30 consecutive days as there was an immediate risk to the safety of children in care. LPA also informed Licensee that this report dated 12/20/2024 documents one Type B citation. Type B citations are a potential risk to the health, safety, or personal rights of children in care.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
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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: JANISZEWSKA FAMILY CHILD CARE
FACILITY NUMBER: 364808870
VISIT DATE: 12/20/2024
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Continued from LIC 809-C (Page 4)

Also, LPA informed Licensee to provide a copy of this licensing report dated 12/20/2024 that documents any Type A citation 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 Acknowledgment of Receipt of Licensing Reports (LIC 9224), or other written statement, must be placed in the child’s file for verification.

An exit interview was conducted and report was reviewed with the licensee, Czeslawa Janiszewska. During the exit interview, Licensee confirmed that there are no registered sex offenders (RSO) living in the facility and LPA completed the RSO profile in the Field Automation System. A notice of site visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
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Document Has Been Signed on 12/20/2024 04:02 PM - It Cannot Be Edited


Created By: Tiffanie Diep On 12/20/2024 at 03:18 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: JANISZEWSKA FAMILY CHILD CARE
FACILITY NUMBER: 364808870

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
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Based on observations, the licensee did not comply with the section cited above as licensee did not ensure multiple hazardous items, including bottles of insect repellent and knives, were inaccessible to children which poses an immediate safety risk to children in care. The bottles of insect repellent were located on a cabinet. A knife was located inside a kitchen drawer that was not secured and additional knives were stored in a drying rack by the kitchen sink.
POC Due Date: 12/23/2024
Plan of Correction
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LPA discussed the requirement to take safety precautions to ensure the home is safe. Licensee placed the items in areas inaccessible to children during the visit.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2024


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Document Has Been Signed on 12/20/2024 04:02 PM - It Cannot Be Edited


Created By: Tiffanie Diep On 12/20/2024 at 03:18 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: JANISZEWSKA FAMILY CHILD CARE
FACILITY NUMBER: 364808870

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
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Based on observation, interview conducted, and records reviewed, the licensee did not comply with the section cited above as licensee did not ensure required immunizations were maintained which poses a potential health risk to children in care.
POC Due Date: 01/20/2025
Plan of Correction
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LPA discussed the requirement to maintain documentation of the required immunizations for all employees and volunteers. Licensee agreed to provide proof of required immunizations for themselves to LPA by 01/20/2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2024


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