Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334830207
Report Date: 08/26/2015 12:00:00 AM
Date Signed 08/26/2015 02:29:21 PM

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:BRACK FAMILY CHILD CAREFACILITY NUMBER:
334830207
ADMINISTRATOR:BRACK, IRMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 541-0996
CITY:INDIOSTATE: CAZIP CODE:
92201
CAPACITY:14CENSUS: 7DATE:
08/26/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:02 PM
MET WITH:Irma BrackTIME COMPLETED:
03:00 PM
NARRATIVE
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A annual/random visit is being conducted as a compliance review (T-1). Licensing Program Analyst Judith Torres toured the facility, inside and out, and the following was observed:

· The facility is operating within the licensed capacity and appropriate ratios
· Appropriate supervision provided during visit
· A working telephone is present
· Appropriate fire extinguisher and smoke detector present
· The fireplace is properly screened
· The facility has adequate heating and ventilation
· Single story home
· All hazardous items inaccessible
· Toxins are locked
· No guns or weapons present as stated by the Licensee Irma Brack
· Outdoor play area is fenced
· No bodies of water
· Clean, safe and age appropriate toys
· Pediatric CPR and First Aid Card expire on 5/2016
· Licensee has required contact information in case of an emergency
· Resident and/or staff records reviewed on 8/26/15 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Judith TorresTELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2015
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: BRACK FAMILY CHILD CARE
FACILITY NUMBER: 334830207
VISIT DATE: 08/26/2015
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· The Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809) must also be posted for 30 days, as well as any documents showing correction of Type A deficiencies. A civil penalty of $100 per violation will be assessed for noncompliance.
· AB 978 – Zero Tolerance Related Regulations went into effect January 18, 2011 – In accordance with California Health and Safety Code Section 1596.99(c)/1597.58(c) – it was explained that an immediate $150 Civil penalty will be assessed for each serious violation and a civil penalty of $150 per day per violation will be assessed until corrected.
· AB 2084 – Nutritious Beverages in Child Care Facilities went into effect January 1, 2012- In accordance with California Health and Safety Code Section 1596.808- licensee was issued a copy of this new law during this visit.
· - Responsibility to know the regulations for anyone providing care
· - Inaccessibility of hazards must be constantly reassessed depending on the children in care
· The licensee is urged to visit the U.S. Consumer Product Safety Commission webpage or hotline at: (800) 638-2772 & e-mail address at www.cpsc.gov to ensure that equipment used for the day care has not been recalled.

Incidental Medical Services was discussed with the Licensee and she stated that she does not provide any IMS care.


An exit interview was conducted, appeal rights discussed and a copy of this report was provided to the licensee on this date.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Judith TorresTELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2015
LIC809 (FAS) - (06/04)
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