Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334840837
Report Date: 04/17/2017
Date Signed 04/17/2017 01:32:25 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:KOLB FAMILY CHILD CAREFACILITY NUMBER:
334840837
ADMINISTRATOR:KOLB, COLLEENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 231-3059
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY:14CENSUS: 6DATE:
04/17/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Licensee, Colleen KolbTIME COMPLETED:
01:40 PM
NARRATIVE
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(3) On April 17, 2017, Licensing Program Analyst (LPA) Sharleen Robinson arrived at the facility to conduct annual visit as part of a compliance review. LPA met with Licensee Colleen Klob . LPA 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-Friday 7:00am-6:00pm
The off-limit areas include: Kitchen, upstairs and garage.

· There were 6 children in care; the facility is operating within the licensed capacity and appropriate ratios. Appropriate supervision provided during visit; licensee advised when temporarily away from the home, the Licensee shall arrange for a substitute adult to care for and supervise children in their absence.

·Present in the home was; a working telephone, appropriate fire extinguisher, smoke detector, and carbon monoxide detector.

·All hazardous items are inaccessible; this includes detergents, cleaning compounds, medications and other items which could pose a danger to children. Storage areas for poisons shall be inaccessible to children and are locked.

· No guns or weapons present as stated by the Licensee. The Licensee was advised and understands all guns, weapons, and ammunition must be key locked separately and made inaccessible per tittle 22 regulations.

·Verification of control of property on file, property owner/landlord notification and consent on file.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4950
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2017
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: KOLB FAMILY CHILD CARE
FACILITY NUMBER: 334840837
VISIT DATE: 04/17/2017
NARRATIVE
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- Access to forms & Regulations for Family Child Care online at www.ccld.ca.gov please subscribe to My CCL on our website. Department updates will be sent directly to your e-mail account once you have set up an account.

- Responsibility to know the regulations for anyone providing care.
- Inaccessibility of hazards must be constantly reassessed depending on the children in care.
- Current facility’s phone numbers must be on file at all times.
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.
- Documentation of fire & earthquake drills to be conducted every six months.

Responsibilities of being a mandated reporter.
- Baby walkers, bouncy seats, exersaucers and other similar items are prohibited.
- The Licensee is urged visit the U.S. Consumer Product Safety Commission webpage at www.cpsc.gov to ensure that equipment purchased for the day care has not been recalled.
- Criminal record clearances required prior to all adults living or working in a Family Child Care Home. A civil penalty of $100.00 per day the person has been present, may be assessed.
- The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

During the exit interview, the Licensee, Licensee Colleen Klob confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

Licensee reminded: when their child(ren) turn 18 years of age, they are required to submit an updated LIC279, LIC508 and TB Screen and have your child submit for LIVESCAN background clearance. This also applies to any adult PRIOR to them moving into the home or who currently lives in the home. Also, PRIOR to employment of any adult, you must submit the LIC508, TB screening and obtain a background clearance through LIVESCAN.

A copy of this report and Notice of site visit was provided to Licensee. Licensee advised the Notice of Site Visit must be posted in a prominent location for the next 30 days.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4950
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2017
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: KOLB FAMILY CHILD CARE
FACILITY NUMBER: 334840837
VISIT DATE: 04/17/2017
NARRATIVE
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·Licensee advised, for more information on SIDS and Safe Sleep Environments, please visit: California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Rick-of-SIDS-in-Early-Education-and-Child-Care And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep

The following was reviewed with the licensee(s):

- AB 2084 - Nutritious Beverages in Child Care Facilities effective January 1, 2012 - was explained that only low-fat or non-fat milk is to be served to children 2 years of age or older; and limit juice to one serving of 100% juice per day; serve no beverages with added sweeteners; and water must be available and accessible to children throughout the day.

- AB 1918 – Smoking prohibition on the premises of Family Child Care Homes, effective January 1, 2015 – This bans smoking tobacco in a home that is licensed as a family child care home, and in those areas of the family child care home where children are present. This change in law was based on demonstrated negative health effects of second and “third hand” smoke on children. Third hand smoke generally refers to the residue from tobacco smoke that sticks to surfaces after the secondhand smoke has cleared.

- AB 2621 – Public information posted on the internet, effective January 1, 2015 – The Department shall post licensing information for Family Child Care Homes on its Internet Web site to include:
· The Name
· The Status of the license
· The number of site visits, including:
Non-complaint inspections
· Substantiated and inconclusive complaint inspections
· The number of citations
This information will be updated at least monthly on the website and will span the preceding five-year period.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4950
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2017
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: KOLB FAMILY CHILD CARE
FACILITY NUMBER: 334840837
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2017
Section Cited
1596.7995
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SB 792 – Effective September 1, 2016, a person may not be employed or volunteer at a child care center or a family child care home unless he or she has been immunized against influenza, pertussis, and measles or
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Licensee agrees to obtain and submit immunizations against influenza, pertussis and measles for herself and her staff.
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qualifies for an exemption (Health and Safety Code sections 1596.7995(a)(1) and 1597.622(a)(1). Licensee and her staff do not have proof of immunizations against influenza, pertussis and measles as required by>>>>>>>>>>>>>>
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SB 792. This poses a potential risk to the Health and Safety of children in care due to licensee not being immunized against measles and/or by not having a medical exemption.
Type B
05/17/2017
Section Cited
102416(c)
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Personnel Requirements. The Licensee and other personnel as specified shall complete training on preventive health practices including pediatric cardiopulmonary resuscitation and pediatric first aid,
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Licensee agrees to submit proof of current Emergency Medical Services Authority (EMSA) approved CPR and First Aid training cards to licensing by 05/17/17
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pursuant to Health and Safety Code Section 1596.866. Licensee's CPR & First aid cards expired 02/28/17.
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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 RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4950
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2017
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: KOLB FAMILY CHILD CARE
FACILITY NUMBER: 334840837
VISIT DATE: 04/17/2017
NARRATIVE
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·Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted.

·Licensees Pediatric CPR and First Aid Card expired on 02/28/17, see LIC809D for citation
Licensees Health & Safety Certificate was completed on 05/15/11

·There is a spa located in the backyard, it is locked per tittle 22 regulations. Licensee reminded all wading pools or similar product must be emptied immediately after use and stored in an upright position when not in use.

·The fireplace and stairs are properly barricaded. The home appears to be clean and orderly with proper heating and ventilation for safety and comfort.

·The outside play area is properly fenced, licensee advised if not properly fenced the Licensee must maintain appropriate supervision.

·Current roster on file, documentation of fire drills on file, and the last drill was conducted 03/9/17

·The licensee was asked to provide information in regard to having an association to any other licensed community care facility. The Licensee states No.

·Resident and/or staff records reviewed on April 14, 2017 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.

·The facility is not currently providing IMS Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 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
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4950
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2017
LIC809 (FAS) - (06/04)
Page: 2 of 6


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: KOLB FAMILY CHILD CARE
FACILITY NUMBER: 334840837
VISIT DATE: 04/17/2017
NARRATIVE
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- AB 2386 – Carbon Monoxide Detector Regulations, effective January 1, 2015 – In accordance with California Health and Safety Code Section 1975.543 - Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12.

- AB 2236 – Civil Penalties, effective July 1, 2015 – Enacts new civil penalties in cases where the Department determines that a violation of licensing standards resulted in the death or serious injury, or constitutes physical abuse of a child in care. The bill establishes an appeal procedure specific to these civil penalties. The bill also expands the scope of the Child Health and Safety Fund in order to assist parents in securing alternative child care when a Child Care Center or Family Child Care Home license has been suspended or revoked. These civil penalty amounts are scaled in relation to the total capacity of all of the licensee’s facilities and not just the specific facility cited or limited to that facility type.

- SB 277 – Immunizations, Personal Beliefs Exemption, effective January 1, 2016 - it eliminates the exemption from existing specified immunization requirements based upon personal beliefs, and only allows an exemption from future immunization requirements deemed appropriate by the State Department of Public Health or a medical professional for medical reasons.

- AB290 – Child Nutrition, effective January 1, 2016 - – In accordance with California Health and Safety Code Section 1596.866 - each family day care home licensee who provides care, shall have at least one hour of childhood nutrition training as part of the preventive health practices course or courses.

- SB792 – Immunization requirements for staff, volunteers, effective September 1, 2016 – In accordance with California Health and Safety Code Section 1597.622 - a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination or they may provide a statement declining the vaccination. If employees/volunteers are receiving the influenza vaccination they must do so between August 1 and December 1 of each year. Licensee and her staff did not have immunizations on file. See LIC809D for citation.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4950
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2017
LIC809 (FAS) - (06/04)
Page: 4 of 6