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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845484
Report Date: 12/22/2021
Date Signed: 12/22/2021 05:45:27 PM

Document Has Been Signed on 12/22/2021 05:45 PM - It Cannot Be Edited

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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:LEWIS FAMILY CHILD CAREFACILITY NUMBER:
334845484
ADMINISTRATOR:LEWIS, AMANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 784-9335
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY: 14TOTAL ENROLLED CHILDREN: 21CENSUS: 18DATE:
12/22/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Licensee Amanda LewisTIME COMPLETED:
06:00 PM
NARRATIVE
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On the above date at approximately 2:25 PM Licensing Program Analysts (LPAs) Susan Brewer and Joanne Domingo arrived for the purpose of conducting a Case Management Inspection. LPAs rang the door bell. Licensee Amanda Lewis, answered the door at approximately 2:28 PM. The licensee A. Lewis, stepped outside the door and stated that the children were getting ready for snack, some children were still napping. LPAs conducted a COVID-19 Pre-Screening, per Licensee A. Lewis, there were a few children with possible runny noses but other than that no confirmed incidents or concerns. The Licensee allowed LPAs entry into the facility to tour. LPAs inquired about the census of children and staff present and the licensee stated that there were 14 children present and 1 staff.

At approximately 2:30 PM, LPA J. Domingo took a census of 18 children and 1 staff present, and located in the outdoor play area. J. Domingo, informed the licensee A. Lewis of the determined census of 18 children present. The licensee stated no there should be only 14 children. LPAs conducted a 2nd census of the daycare children present and observed 1 staff caring for 6 infants and toddler children seated in highchairs, 1 child in the trampoline, and 11 children seated a long table in the outdoor activity area. LPAs re-entered the home and informed the licensee A. Lewis, that she would need to contact parents to pick up the children, since the facility was out of ratio and over capacity. A. Lewis, stated that she already contacted parents to start picking up the children. LPA J. Domingo conducted a file review and determined that 2 children present were not listed on the facility roster. At 4:00 PM, LPAs toured the facility inside and out. At 4:03 PM, LPA S.Brewer observed a set of glass pipes and other rubber hooka pipes in the master bathroom and a portable gas burner with ashes, along with tobacco. The licensee stated that there is no smoking in the home and the tobacco does not have nicotine. LPA observed 1 of 2 cans of tobacco to contain nicotine. At 4:05 PM, LPA S. Brewer, continued the inspection tour downstairs observed 6 cribs, one cot and an inclined swing with a blanket in the downstairs bedroom used for napping. No children were present in the napping room. A camera is placed in the napping room and the licensee stated that she and the staff are in and out of the room, and do not rely solely on the cameras for supervision of children napping.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2021
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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Document Has Been Signed on 12/22/2021 05:45 PM - It Cannot Be Edited


Created By: Susan Brewer On 12/22/2021 at 04:23 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 334845484

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/22/2021
Section Cited
CCR
102416.5(d)(1)

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102416.5 (d)(1) Staffing Ratio and Capacity: (d) For a Large Family Child Care Home, the maximum number of children for whom may be provided ... shall be either: (1) Twelve children, no more than four of whom may be infants. This regulation was not met as evidenced by:
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Per A. Lewis, the licensee stated she will ensure that she complies with regulation, by always staying within ratio and making sure that staff are aware of the regulations as well.
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At approximately 2:33 PM, LPAs took a census of children in care and observed the Licensee A. Lewis & 1 staff providing care for 5 infants and 13 children over the age of 2, determining the facility to be out of ratio, which poses an immediate risk to the health and safety of children in care.
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Per Amanda Lewis, she will provide a written statement to Community Care Licensing, with the understanding of staying within licensed ratios and submit the statement to CCL, by 12/23/2021, by mail, fax, or e-mail.
Type A
12/22/2021
Section Cited
CCR102416.5(d)(2)

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102416.5(d)(2) Staffing Ratio & Capacity: (d) For a Large FCCH, the max umber of children for whom care may be provided at any one time when there is an assistant...(2) More than 12 & up to 14 children only if the criteria in Section 1597.465 of the Health & Safety Code are met. This regulation was not met as evidenced by:
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Per A. Lewis, the licensee stated she will ensure that she complies with regulation, by always staying within the licensed capacity and making sure that staff are aware of the regulations as well.
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At approximately 2:33 PM, LPAs took a census of children present at the faciiity and observed 18 children in care of the Licensee A. Lewis & 1 staff, where the facility exceeded their licensed capacity & fire code, which poses an immediate risk to the health & safety of children in care.
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Per Amanda Lewis, she will provide a statement to Community Care Licensing, with the understanding of not exceeding the licensed capacity approved by the fire department & CCL. The licensee stated she will submit a written statement to CCL, by 12/23/2021, by mail, fax, or e-mail.
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:Pauline Beschorner
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2021


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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 334845484
VISIT DATE: 12/22/2021
NARRATIVE
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The Licensee A. Lewis, stated that the cameras are used for personal use only. LPA J. Domingo, conducted a review of Children's records and determined that 5 out of 18 children present were infants under the age of 2 years old.

· Criminal record clearances are 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. Resident and/or staff records reviewed on 12/21/2021 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.
The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: [email protected]
- 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, exe-rsaucers and other similar items are prohibited
- The applicant 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
- Access to forms & Regulations for Family Child Care online at www.ccld.ca.gov.

- Please subscribe at [email protected] to receive Department updates. They will be sent directly to your e-mail account once you have set up an account. This website can also be accessed through www.ccld.ca.gov

- 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 Amanda Mallison, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 334845484
VISIT DATE: 12/22/2021
NARRATIVE
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A fire inspection 02/2020 approved for a capacity of 12 and up to 14 children, which the licensee Amanda Lewis exceeded, during the inspection of the facility.

See Type A Citations for Title 22 regulations 102416.5(d)(1) Staffing Ratio and Capacity and 102416.5 (d)(2) Staffing Ratio and Capacity.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility for the next 12 months, The licensee understands that the LIC9224 shall be provided to parents, signed a copy of the form placed in the children's files.

Appeal Rights were reviewed and provided.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS.

A copy of this report was provided to the Licensee A. Lewis on this 12/22/2021 and must be made available to the public upon request for the next 3 year
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
LIC809 (FAS) - (06/04)
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