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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300495
Report Date: 04/19/2024
Date Signed: 04/19/2024 10:46:22 AM

Document Has Been Signed on 04/19/2024 10:46 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:LEWIS FAMILY CHILD CAREFACILITY NUMBER:
336300495
ADMINISTRATOR/
DIRECTOR:		LEWIS, AMANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 784-9335
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
04/19/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Amanda Lewis TIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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On the listed date and time Licensing Program Analysts (LPA) Gabriela Hernandez and Licensing Program Manager (LPM) Pauline Beschorner arrived at the facility to conduct a Case Management inspection as a result of information disclosed during an investigation of complaint 10-CC-20240229104014. During that investigation, interviews revealed Licensee has been absent on multiple occasions for more than 20% of the day care hours to deal with personal matters. Licensee also confirmed this to be true as well. There were also 2 separate incidents where children in care were injured, and Licensee failed to contact CCL either by fax or telephone within the next business day. Both incidents required children to seek medical treatment.

Based on interviews, and record review, the licensee did not comply with California Code of Regulations Title 22 102417(a) and 102416.2(d). Both incidents pose a potential health and safety risk to children in care. Citations will be issued on the LIC 809D.

An exit interview was conducted a copy of this report, LIC 9224 and appeal rights were discussed and provided to Licensee Amanda Lewis. A Notice of Site Visit was also provided and must remain posted for 30 days.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Gabriela Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2024
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 04/19/2024 10:46 AM - It Cannot Be Edited


Created By: Gabriela Hernandez On 04/19/2024 at 09:34 AM
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: 336300495

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/19/2024
Section Cited
CCR
102417(a)

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102417 Operation of a Family Child Care Home (a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.
This requirement was not met as evidence by…
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Licensee has submitted paperwork to add co-licensee so licensee can be absent to handle with personal matters.
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Based on interviews and record review the Licensee admitted to being absent on multiple occasions for personal matters for more than 20% of the time. This poses a potential health and safety risk to the children in care.
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Type B
04/26/2024
Section Cited
CCR102416.2(d)(2)

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102416.2 Reporting Requirements (d) The licensee shall report to the Department as provided by Health and Safety Code Sections 1597.467(b)(1) and (2). This requirement was not met as evidenced:
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Licensee will review regulation with staff and submit written statement to LPA that they have reviewed and understand the regulation. Licensee also stated she understands now that she is required to notify CCLD within next business day when an incident occurs.
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Based on record review Licensee failed to report to the department by telephone or fax that a child was injured and required medical attention within the next business day, and within 7 days of the incident which poses a potential health and safety risk to children in care.
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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:Pauline Beschorner
LICENSING EVALUATOR NAME:Gabriela Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2024


LIC809 (FAS) - (06/04)
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