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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845095
Report Date: 04/04/2024
Date Signed: 04/04/2024 12:30:44 PM

Document Has Been Signed on 04/04/2024 12:30 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:GREEN FAMILY CHILD CAREFACILITY NUMBER:
364845095
ADMINISTRATOR/
DIRECTOR:		BRENDA GREENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 587-6270
CITY:ONTARIOSTATE: CAZIP CODE:
91764
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
04/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Brenda GreenTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On 08/09/23, and the time listed above, Licensing Program Analysts (LPAs) Aman Lama and Giselle Carbullido made an unannounced visit to the facility for another matter. LPAs met with Licensee, Brenda Green and took a tour of the facility.

During the tour of the facility,LPAs observed personal hygiene products; toothpaste tubes, shampoo and oral rinse, labeled: keep out of reach of children to children in their designated on-limits restroom, found under the sink and in the bathroom drawers. Additionally, there was a "Clorox" disinfectant spray observed in an open trash bag, on the floor near the on-limits restroom. Licensee was cited for accessible poisons and toxins on an unannounced inspection on 06/28/2023 and again on 08/09/2023. Additionally, LPAs observed an infant sleeping with a blanket in on of the cribs. Licensee was cited for Safe Sleep Regulations.

See LIC809D for all citation(s).

Payment is due when billed and the check(s) or money orders shall be made payable to the "California Department of Social Services". YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

LPA Aman Lama informed licensee Brenda Green that this report dated 04/04/24 document(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.

Also, LPA informed the licensee Brenda Green to provide a copy of this licensing report dated 04/04/24 that documents any Type A citation(s) to parents 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 (LIC9224), or other written statement must be placed in the child's file for verification.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2024
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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Document Has Been Signed on 04/04/2024 12:30 PM - It Cannot Be Edited


Created By: Aman Lama On 04/04/2024 at 11:00 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: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 364845095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/05/2024
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, 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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Additionally, LPA observed a "Clorox: cleaning spray in the trash can near the floor of the on-limits restroom.
Type A
04/04/2024
Section Cited
CCR102425(b)

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Cribs or play yards shall be free from all loose articles and objects. This requirement is not evidenced by: Upon arrival, there was an infant sleeping in the crib with a blanket wrapped around them. This poses an immediate health and/or safety risk to children in care.
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Licensee agrees to submit proof of watching "safe sleep videos" which she can find on the home page, ccld.ca.gov and submit proof of understanding via signature and date, for herself and her assistant. This is due to licensing no later than the POC due date.

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


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/04/2024 12:30 PM - It Cannot Be Edited


Created By: Aman Lama On 04/04/2024 at 11:40 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: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 364845095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/04/2024
Section Cited
CCR
102417(g)(3)

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Where children are less than five years old are in care, stairs shall be fenced or barricaded. This was not met as evidenced by: LPA's immediately observed the gate to the stairs wide open, making the stairs accessible to the children in care. This poses a potential risk to the health and safety to
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Licensee immediately closed the gate and agrees to keep gate closed during day care hours.
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children in care.
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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 Lama
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2024


LIC809 (FAS) - (06/04)
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