Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818540
Report Date: 07/31/2015 12:00:00 AM
Date Signed 07/31/2015 04:51:48 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:RAYMOND FAMILY CHILD CAREFACILITY NUMBER:
364818540
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
07/31/2015
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Peggyl RaymondTIME COMPLETED:
05:00 PM
NARRATIVE
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The licensee has applied to increase her capacity to that of a Large Family Child Care Home. Licensing Program Analyst (LPA) Yolanda Jackson toured the facility, inside and out, records were reviewed and the following was observed:
· Appropriate fire extinguisher, smoke detector and carbon monoxide detector present
Off limit areas include bedroom #1 located on the south side of hallway and the garage area located in a separate dwelling in the backyard.
· All hazardous items inaccessible
· Toxins locked
· No guns or weapons present
· Single story home
· The fireplace is properly screened
· Verification of control of property on file
· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted
· Pediatric CPR and First Aid Card - expires on 12/7/2015
· Health & Safety Certificate - completed on 1/20/2007
· No bodies of water or toxic plants at this time
· Clean, safe and age appropriate toys
· Current roster on file
· Documentation of fire drills on file (Last drill 2/24/15)
· Children’s records are complete
· Fire Clearance obtained on 6/25/15
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Yolanda JacksonTELEPHONE: (951) 897-5637
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2015
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: RAYMOND FAMILY CHILD CARE
FACILITY NUMBER: 364818540
VISIT DATE: 07/31/2015
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·The licensee was advised that 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 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.
· A review of resident and/or staff records on **date** indicates that all facility staff or other individuals who require caregiver background checks (adults living in the facility) have received criminal record and child abuse index clearances or exemptions.

- AB 978 – Zero Tolerance Related Regulations went into effect January 18, 2011 – In accordance with California Health and Safety Code Sections 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.

There are no deficiences at time of visit.

The application for a Large Family Child Care Home will be submitted for approval with a maximum capacity of 12 or 14 with parent notification and presence of an assistant. An exit interview was conducted, appeal rights discussed and a copy of this report was provided to the licensee on this date.

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


A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Yolanda JacksonTELEPHONE: (951) 897-5637
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2015
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: RAYMOND FAMILY CHILD CARE
FACILITY NUMBER: 364818540
VISIT DATE: 07/31/2015
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The following was reviewed with the licensee(s):
· Mandatory Forms for the children’s files and provider’s files
- AB 633 – Parent Notification Requirements effective January 1, 2007 – were explained during this visit. Parent Notification Requirements form LIC 9224 (12/06) & AB 633 Fact Sheet left at facility.
· The licensee was advised how to access forms and Regulations for Family Child Care online at www.dss.cahwnet.gov
· The licensee was advised that without a qualified assistant present, the capacity and ratios revert back to those of a small Family Child Care Home.
· The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care
· Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified
· There is a $100.00 Civil Penalty initially for any adult not fingerprint cleared working or living at the facility, however, as of January 1, 2005, Civil penalty for any adult not fingerprint cleared working or living at the facility or persons previously cleared through the Department of Social Services not associated to facility, can be cited civil penalty up to $500.00 for the 1st offense and up to $3000.00 for the 2nd offense within a 12 month period, per person.
· The licensee was advised that the PUB72 “What are Parents’ Responsibilities?” handout must be provided to each parent with the Notification of Parent’s Rights.
· Upon a finding of noncompliance with a plan of correction for violation of Sections 102419(a)(8), (b), (c), (d), (d)(1), or (d)(2), the Department shall impose a civil penalty of fifty dollars ($50) per day until the deficiency is corrected. Regardless of whether the licensee complies with an initial plan of correction in the time allotted, if the licensee subsequently violates any provision of these sections within 12 months of the initial citation, the Department shall assess a civil penalty of $150 plus an assessment of $50 per day until the deficiency is corrected. Regardless of whether the licensee complies with the subsequent deficiency plan of correction, if the licensee again violates any provision of these sections within 12 months of the subsequent citation and civil penalty assessment, the Department shall assess a civil penalty of $150 plus an assessment of $150 per day until the deficiency is corrected.
· The licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the timeframe specified in regulation and on the form LIC624B (6/03)
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Yolanda JacksonTELEPHONE: (951) 897-5637
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2015
LIC809 (FAS) - (06/04)
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