Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841453
Report Date: 10/19/2017
Date Signed 10/19/2017 02:49:39 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:BOOKER/SKINNER FAMILY CHILD CAREFACILITY NUMBER:
364841453
ADMINISTRATOR:BOOKER,S/SKINNER,MFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 728-3445
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY:14CENSUS: 12DATE:
10/19/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Stacy BookerTIME COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
(3) On date and time listed, Licensing Program Analyst (LPA) Diana Brasel arrived at the facility to conduct an annual visit. Upon arrival LPA was granted access by the licensee's 2 adult assistant's. LPA observed most of the 10 children already napping or beginning to nap. The licensee arrived a few moments after LPA's arrival and one additional staff. Two additional children arrived during the visit. 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 6:00 am - 6:30 pm. OFF-LIMIT AREAS INCLUDE: The entire upstairs, down stairs bedroom and office, and garage. The backyard is off limits with no bodies of water. The licensee uses the front yard for outdoor play with direct supervision at all times. The licensee also stated, they go to the near by park for outdoor play.
· The licensee is present in the home and ensures that children in care are supervised at all times.
· The licensee is operating within the licensed capacity and ratios.
· Fire extinguishers, smoke detectors, and carbon monoxide detectors meet State Fire Marshall
standards and were tested by the applicant during this visit.
· Fireplaces and open face heaters are screened to prevent access by children..
· Where children less than five years old are in care, stairs are fenced or barricaded.
· Storage areas for poisons, detergents, cleaning compounds, medications and other items which
could pose a danger to children are stored where they are inaccessible to children.
· All poisons are locked.
· No dangerous weapons at the facility, per the licensee Stacy Booker.
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Diana BraselTELEPHONE: 951-782-4949
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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: BOOKER/SKINNER FAMILY CHILD CARE
FACILITY NUMBER: 364841453
VISIT DATE: 10/19/2017
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
returning to the home or having contact with children in care.
· Children are not left in parked vehicles and the licensee understands that this is prohibited.
· The licensee understands that any authorized employee of the Department may enter and inspect
any place providing personal care and services at any time, with or without advance notice.
· 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
· 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 Januay 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.
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Diana BraselTELEPHONE: 951-782-4949
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2017
LIC809 (FAS) - (06/04)
Page: 3 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: BOOKER/SKINNER FAMILY CHILD CARE
FACILITY NUMBER: 364841453
VISIT DATE: 10/19/2017
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
· The home is kept clean and orderly, with heating and ventilation for safety and comfort.
· Each child has safe, healthful, and comfortable accommodations, furnishings, and equipment.
· The home provides safe toys, play equipment, and materials.
· No bodies of water on today's visit. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position when not in use.
· The home has a current roster of children.
· The home conducts fire and disaster drills at least once every six months, and documents the date
and time of each drill. Last drill conducted 06/23/2017.
· Licensee documents immunization's and maintains and updates records for children in care.
· Licensee provides the child's parent or representative with a copy of the Family Child Care Home
Notification of Parents' Rights.
· The licensee and other personnel, as specified, have completed training on preventive health
practices which is on file. Licensee's and all staff have current CPR and First Aid which expires
07/2019.
· The licensee was asked to provide information in regard to having an association to any licensed
community care facility.
· Resident and/or staff records reviewed on 10/19/2017 indicate that all adults who require caregiver
background checks have received all required clearances or exemptions.
· The licensee understands that failure to obtain required clearances may result in a civil penalty
assessment of $100.00 per day the person has been present.
· The licensee understands that upon notice of the Department to remove an individual from the
home, pursuant to H&S Code 1596.871(c)(2), or to exclude an individual from the home, pursuant
to H&S Code 1596.8897, the licensee immediately removes the individual and prevents them from
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Diana BraselTELEPHONE: 951-782-4949
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2017
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: BOOKER/SKINNER FAMILY CHILD CARE
FACILITY NUMBER: 364841453
VISIT DATE: 10/19/2017
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
- 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 “thirdhand” smoke on children. Thirdhand 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.
- 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. The department shall account for the presence of these detectors during inspections
- 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
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Diana BraselTELEPHONE: 951-782-4949
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2017
LIC809 (FAS) - (06/04)
Page: 6 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: BOOKER/SKINNER FAMILY CHILD CARE
FACILITY NUMBER: 364841453
VISIT DATE: 10/19/2017
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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 – Immunization's, 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.
- Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov
- 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.
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Diana BraselTELEPHONE: 951-782-4949
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2017
LIC809 (FAS) - (06/04)
Page: 4 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: BOOKER/SKINNER FAMILY CHILD CARE
FACILITY NUMBER: 364841453
VISIT DATE: 10/19/2017
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
- 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 applicant is urged visit the U.S. Consumer Product Safety Commission web-page 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.
- Once licensed, 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/LIC9099) must also
be posted for 30 days. A civil penalty of $100 per violation will be assessed for noncompliance.
- The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO
(1-844-538-8766).

No cited deficiencies.
During the exit interview, the licensee, Stacey Booker, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.
As a REMINDER: any adult PRIOR to them moving into the home or prior to employment must submit the LIC508, TB screening, obtain a background clearance through LIVESCAN and be associated.

A notice of site visit was issued and is to be posted in a prominent location at the facility for the next 30 days. A copy of this report was provided to the licensee on this date and must be made available to the public upon request for the next 3 years.

A Confidential Names List was completed and provided to the licensee.
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Diana BraselTELEPHONE: 951-782-4949
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2017
LIC809 (FAS) - (06/04)
Page: 5 of 6