Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841425
Report Date: 03/21/2016
Date Signed 03/21/2016 01:34:35 PM

COMPREHENSIVE INSPECTION
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:MULLER FAMILY CHILD CAREFACILITY NUMBER:
364841425
ADMINISTRATOR:MULLER, SUMMERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 995-6841
CITY:PINON HILLSSTATE: CAZIP CODE:
92372
CAPACITY:14CENSUS: 14DATE:
03/21/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Summer Muller, Licensee TIME COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analyst (LPAs) Sharleen Robinson and Samuel Lopez completed an unannounced Annual site inspection. LPAs met with Licensee, Summer Muller. LPAs advised Licensee that the purpose of the visit is to ensure the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. LPAs and Licensee; toured and inspected the 4 bedroom 4 bathroom two level home, inside and out to ensure a safe and healthful environment for children, the following was observed:

There were 14 children in care, proper supervision and ratios observed. Day care areas are; family room, formal dining room bathroom #1. Off limit areas include the entire upstairs, the garage, the laundry room and kitchen. Appropriate fire extinguisher, smoke detector and carbon monoxide detector present. All hazardous items inaccessible, toxins locked, no guns or weapons present, the home had a working telephone, provided appropriate heating and ventilation, appeared to be clean and organized. The fireplace is properly screened, stairs are barricaded. Facility Sketch, Emergency Disaster Plan and Notification of Parent’s Rights poster were posted. Documentation of fire drills on file, the last drill was conducted 10/19/15.

There is spa located in the back yard; the spa cover is secured to the spa with four locks. No toxic plants observed during visit, the back yard was fenced; there were clean, safe and age appropriate toys available for day care children. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions, staff # 1 is missing TB screening see LIC809D for citation. Licensee’s First Aid and CPR certifications expire 2/28/17. The roster was not current, See LIC809D for citation. Children’s records were reviewed, children # 5 and #7 are missing immunization records, see LIC809D for citation. Licensee is not providing incidental medical services at this time. See LIC809C for the remainder of the report.
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4950
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2016
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: MULLER FAMILY CHILD CARE
FACILITY NUMBER: 364841425
VISIT DATE: 03/21/2016
NARRATIVE
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Licensee was reminded to: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in the home have criminal background clearances to avoid civil penalties associated with this requirement; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. SIDS and Shaken Baby Syndrome were discussed.

An exit interview was conducted, appeal rights discussed, a copy of this report, appeal rights, and notice of site visit was provided to the licensee on this date.
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4950
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2016
LIC809 (FAS) - (06/04)
Page: 3 of 3


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: MULLER FAMILY CHILD CARE
FACILITY NUMBER: 364841425
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/25/2016
Section Cited
102417(g)(8)
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Operation of a Family Child Care Home. All homes shall have a current roster of the children. The facility roster did not list all children in care.
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Licensee agrees to submit a copy of the completed roster to CCL by 03/25/16.
Type B
03/25/2016
Section Cited
102418(a)
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Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. Children #5 and 7 did not have Immunization records on file.
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Licensee agrees to submit a copy of the immunization record to CCL by 03/25/16.
Type B
03/25/2016
Section Cited
102369(b)(9)
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Application for License. Licensees and any adult in the home, shall provide evidence of a current tuberculosis clearance, performed and signed by a physician not more than one year prior to or seven days
after first day of employment.
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Licensee agrees to submit a copy of the tuberculosis clearance to CCL by 04/01/16.
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Staff #1 Did not have evidence of a current tuberculosis clearance, performed and signed by a physician on file
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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: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4950
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2016
LIC809 (FAS) - (06/04)
Page: 2 of 3