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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845095
Report Date: 08/09/2023
Date Signed: 08/09/2023 04:57:15 PM

Document Has Been Signed on 08/09/2023 04:57 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GREEN FAMILY CHILD CAREFACILITY NUMBER:
364845095
ADMINISTRATOR:BRENDA GREENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 587-6270
CITY:ONTARIOSTATE: CAZIP CODE:
91764
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
08/09/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Brenda GreenTIME COMPLETED:
05:00 PM
NARRATIVE
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On 08/09/23, and the time listed above, Licensing Program Analysts (LPAs) Aman Sharma and Justin Giese made an unannounced visit to the facility for the purpose of proof of corrections for citations issued during an unannounced visit to the facility on 06/28/2023. LPAs met with Licensee, Brenda Green and discussed the purpose of the visit.

The following Citations were cleared at time of visit:

1. Criminal Records Clearance - LPA's checked roster and confirmed all adults were fingerprint cleared and associated to the facility roster.
2. Hole in Kitchen ceiling has been patched and hazardous chemicals were removed from the top of the children's fridge.

LPA observed citations that have not been cleared from the annual inspection from 06/28/23.

LPA observed personal hygiene products; toothpaste tubes, shampoo and oral rinse, labeled: keep out of reach of children to children in their designated bathroom, found under the sink and in the bathroom drawers. Licensee was cited for accessible poisons and toxins on an unannounced inspection on 06/28/2023. The facility was found to be in violation of the following Title 22 regulations:

102417(g)(4) Operation of a Family Child Care Home:
(g)(4) Poisons, detergents, cleaning compounds... and other items which could pose a danger... to children shall be stored where they are inaccessible to children. See LIC809D for Type A citation.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 364845095
VISIT DATE: 08/09/2023
NARRATIVE
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Licensee was cited on 06/28/23 for not documenting 15-minute sleep checks for the infants in care. During this visit, licensee still did not begin to implement 15-minute checks. Licensee also did not submit proof of enrollment for CPR/First Aid training, or mandated reporter training for both, herself and her assistant.

This is a repeat violation that has not been corrected since the last inspection on 06/28/23.

The following corrections were also not cleared:

1. Safe Sleep: Proof of 15 minute checks for infants. Infants are up to 24 months of age.
2. Personnel Requirements- Proof of CPR/First Aid Certificate
3. Personnel Requirements- Mandated reporter training, specifically for Child Care Providers.

Licensee was made aware and agreed to adhere to stated POC due dates for current and outstanding deficiencies. Exit interview conducted and report was reviewed with Licensee, Brenda Green.

LPA issued a Notice of Site Visit and verified it was posted in a prominent location at the facility. Licensees understands that the Notice of Site Visit must remain posted for the next 30 days along with a copy of all Type A deficiencies cited during this inspection. A copy of all Type A deficiencies cited during this inspection must also be immediately (within 24 hours of child’s next day in care) given to the parents of all children enrolled in the child care facility and any children enrolled into the child care facility over the next 12 months (at the time of enrollment). Licensees are required to have all parents sign and date the Acknowledgement of Receipt of Licensing Reports (LIC9224) and maintain a copy in each child’s file. A copy of this report, LIC9224 and Appeal Rights (LIC9058) were provided during this inspection.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/09/2023 04:57 PM - It Cannot Be Edited


Created By: Aman Sharma On 08/09/2023 at 04:22 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: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 364845095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/10/2023
Section Cited
CCR
102417(g)(4)

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(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
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Licensee agrees to remove all hazards in the on-limits restroom and submit POC to licensing no later than the POC due date.
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they are inaccessible to children.
This requirement is not met as evidenced by:LPA observed personal hygiene products; toothpaste tubes, shampoo and oral rinse, labeled: keep out of reach of children to children in their designated bathroom, found under the sink and in the bathroom drawers.
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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:Kimberly Williams
LICENSING EVALUATOR NAME:Aman Sharma
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2023


LIC809 (FAS) - (06/04)
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