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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364819798
Report Date: 04/16/2024
Date Signed: 04/16/2024 11:40:17 AM

Document Has Been Signed on 04/16/2024 11:40 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:INGRAM FAMILY CHILD CAREFACILITY NUMBER:
364819798
ADMINISTRATOR/
DIRECTOR:		INGRAM, NICOLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 422-9938
CITY:GRAND TERRACESTATE: CAZIP CODE:
92313
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
04/16/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Donae Smith, AssistantTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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On 04/16/2024 at 09:00 AM, Licensing Program Analysts (LPAs) Raymond Moorehead and Susan Brewer arrived at the facility to conduct a required/annual inspection as part of a compliance review. LPAs were greeted and granted access by Licensee's Assistant (S1). LPAs reached out to Licensee, Licensee stated that she was away from the facility. Licensee's Assistant Donae Smith (S3) arrived to the facility at 9:21 AM and was present for the inspection. At 9:22 AM, Licensee stated that she was not able to return to the facility due to unforeseen circumstances. Inspection continued with the facility's staff members. 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 through Friday, 5:30 AM to 6:00 PM

OFF-LIMIT AREAS INCLUDE: All bedrooms and the garage.

The facility is operating within the licensed capacity and appropriate ratios.


· Appropriate supervision was provided during this inspection.

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

· Appropriate fire extinguisher, smoke detector and carbon monoxide detector were present and tested by the staff during this inspection.

· Fireplace is properly screened to prevent access by children.

· All hazardous items are stored inaccessible to children.

· Toxins are locked.

· Weapons are not present/stored in the home according to Donae Smith, Assistant. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: INGRAM FAMILY CHILD CARE
FACILITY NUMBER: 364819798
VISIT DATE: 04/16/2024
NARRATIVE
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· Stairs are not present in the home.

· Verification of control of property is on file.

· Property Owner/Landlord Consent (LIC 9149)/Notification (LIC 9151) is on file.

· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights posters are posted.

· Mandated Reporter Training Certificate expires on 04/2025

· Pediatric CPR and First Aid Card expires on 04/2025 (Donae Smith, Assistant)

· Health & Safety Certificate - completed on 11/04/2007

· No bodies of water are present at this time. 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 were observed at the time of the visit.

· Current roster is on file.

· Documentation of fire and disaster drills are on file – Last drill was conducted on 01/16/2024

· Children’s records are complete.

· Employee’s records not are 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 04/16/2024 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

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: INGRAM FAMILY CHILD CARE
FACILITY NUMBER: 364819798
VISIT DATE: 04/16/2024
NARRATIVE
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- LPA discussed the safe sleep regulations with Donae Smith, Assistant 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 Donae Smith, Assistant 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)/ (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

- Donae Smith, Assistant 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.

- 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.

- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
951-782-4200 and/or 1-844-LET-US-NO (1-844-538-8766)

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/16/2024 11:40 AM - It Cannot Be Edited


Created By: Raymond Moorehead On 04/16/2024 at 10:40 AM
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: INGRAM FAMILY CHILD CARE
FACILITY NUMBER: 364819798

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

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 in count of 1 person which posed a potential health and safety risk to persons in care. Licensee's Assisant's (S1) CPR & 1st Aid Card expired on 03/2024. S1 was supervising children with no other adult present that had a current CPR & 1st Aid Card.
POC Due Date: 04/23/2024
Plan of Correction
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Licensee agrees to have S1 get enrolled in a EMSA approved CPR & 1st Aid Card course by 04/23/2024. Licensee agrees to send proof of enrollment to LPA via email by 04/23/2024 by 5:00 PM. Licensee also agrees to submit S1's CPR & 1st Aid Card one recieved. Email to: Raymond.Moorehead@dss.ca.gov
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:Aaron Ross
LICENSING EVALUATOR NAME:Raymond Moorehead
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024


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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: INGRAM FAMILY CHILD CARE
FACILITY NUMBER: 364819798
VISIT DATE: 04/16/2024
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The licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

Exit interview conducted and report was reviewed with Donae Smith, Assistant. Appeal rights were discussed and provided for the licensee. 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. See LIC809-D for cited deficiency.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
LIC809 (FAS) - (06/04)
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