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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364816117
Report Date: 10/07/2024
Date Signed: 10/07/2024 01:20:19 PM

Document Has Been Signed on 10/07/2024 01:20 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:CHAVEZ FAMILY CHILD CAREFACILITY NUMBER:
364816117
ADMINISTRATOR/
DIRECTOR:		CHAVEZ, DOLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 782-8833
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 5DATE:
10/07/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Dolores Chavez TIME VISIT/
INSPECTION COMPLETED:
01:35 PM
NARRATIVE
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On the date and time listed, Licensing Program Analyst (LPA) Aman Lama arrived at the facility to conduct an annual inspection. Upon arrival, LPA was met with licensee, Dolores Chavez. Licensee granted access to LPA who then toured the on-limits indoor and outdoor areas of the facility.

Normal days and hours of operation are listed as: Monday-Friday 6:00am-6:00pm.

OFF-LIMIT AREAS ARE LISTED AS FOLLOWS: All bedrooms, the garage and outdoor side yard.



**Any updates to any forms (LIC279, LIC610, LIC999, etc) must be submitted to the Riverside Regional Office (RRO) within the next 30 days.

· A working telephone is present and current phone number is on file.

· Appropriate fire extinguisher, smoke detector and carbon monoxide detector were all in working order.

· LPA observed hazards accessible to daycare child(ren). Licensee was reminded the difference between which items to keep under lock and which to keep behind a latch, and how to read labels to determine-SEE LIC809D.

· No guns/weapons currently kept in the home. All guns, weapons and ammunition must be key locked separately and made inaccessible, per Title 22 Regulations.

· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster were posted in the home.

· Mandated Reporter Training certificate for licensee expires: 11/15/2024. **Licensee is reminded to update mandated reporter training for “Child Care Providers” at mandatedreporterca.com, every 2 years.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2024
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 6
Document Has Been Signed on 10/07/2024 01:20 PM - It Cannot Be Edited


Created By: Aman Lama On 10/07/2024 at 12:47 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: CHAVEZ FAMILY CHILD CARE
FACILITY NUMBER: 364816117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2024

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 observation, the licensee did not comply with the section cited above. Children were playing in the "Play room" of the home. LPA observed the following: The kitchen had a "Lysol" Cleaning spray and "Lysol" disinfectant spray next to food/snacks. Additionally, there was "Clorox" powdered bleach out next to the sink in the kitchen as well as another unknown cleaning agent. In the on-limits "Children's bathroom", there was a gallon of "antibacterial hand soap" which was left on the floor of the shower, with the shower sliding door open. The warning label indicates to contact poison control, "if swallowed". Lastly, LPA observed multiple body mists in the bathroom cabinet under the sink, and a box of Clorox wipes on top of the toilet. Due to the age of the children in care, this poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/07/2024
Plan of Correction
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Immediately, licensee removed all items and placed them behind a key lock or in an off-limit area with a key lock of the home, making these items inaccessible.
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:Gilbert Sena
LICENSING EVALUATOR NAME:Aman Lama
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/07/2024 01:20 PM - It Cannot Be Edited


Created By: Aman Lama On 10/07/2024 at 12:47 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: CHAVEZ FAMILY CHILD CARE
FACILITY NUMBER: 364816117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Licensees last documentation of a disaster drill was 03/2024. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/11/2024
Plan of Correction
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Licensee agrees to conduct a disaster drill with the children. Licensee also agrees to keep a running record of these drills, which should be conducted at least every 6 months.
Type B
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. An individual that is 18/over resides in the home & has not received a fingerprint clearance. Due to licensee showing proof of having sent the individual for a fingerprint clearance request, this is being downgraded to a Type B citation. The facility is being cited due to fingerprints being "in process" for over 6 weeks, with no action taken by the licensee. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/31/2024
Plan of Correction
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Licensee agrees to re-submit fingerprint clearance and obtain a clearance for the individual mentioned above. Proof of this shall be sent to the department no later than the POC due date.
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:Gilbert Sena
LICENSING EVALUATOR NAME:Aman Lama
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2024


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: CHAVEZ FAMILY CHILD CARE
FACILITY NUMBER: 364816117
VISIT DATE: 10/07/2024
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·Pediatric CPR and First Aid Card for licensee expires: 12/2025.

· Health & Safety Certificate has been completed by licensee is on file.

· Bodies of water were not observed on property at this time. All bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains were observed to be properly fenced per Title 22 Regulations. The Department must be notified before and after installation of any 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.

· LPA observed Clean, safe and age appropriate toys available for children.

· Documentation of last fire/disaster drill was unavailable. Last drill conducted: November 2023.

· 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 indicate that all adults who require caregiver background checks have not received all required clearances or exemptions-SEE LIC809D .

· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations862@dss.ca.gov

-Licensee is not currently administering medications. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes 102417. 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: http://www.ada.gov/childqanda.htm

- The licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
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: CHAVEZ FAMILY CHILD CARE
FACILITY NUMBER: 364816117
VISIT DATE: 10/07/2024
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- To receive Provider Information Notices (PINs), go to the licensing webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the “Quick Links”. You can add your email address and choose which program(s) to receive PINs for.

- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at: 951-782-4200.

The licensee, Dolores Chavez confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

See LIC809-D for cited deficiencies.



LPA Aman Lama informed licensee, Dolores Chavez that this report dated October 07, 2024 document(s) (1) 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.

Exit interview was conducted and report was reviewed with the licensee, Dolores Chavez.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
LIC809 (FAS) - (06/04)
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