<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845824
Report Date: 04/07/2023
Date Signed: 06/01/2023 05:10:14 PM

Document Has Been Signed on 06/01/2023 05:10 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:BUBELLO FAMILY CHILD CAREFACILITY NUMBER:
364845824
ADMINISTRATOR:BUBELLO,BARBARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 549-4594
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
04/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Barbara Bubello TIME COMPLETED:
04:05 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
****AMENDED REPORT: THE DEFICIENCY CITED ON THIS CASE MANAGEMENT REPORT WAS REMOVED AND CITED UNDER SUBSTANTIATED COMPLAINT DATED 04/19/23****

On 04/07/2023 at 2:50pm, a case management visit was completed by Licensing Program Analyst (LPA) Aman Sharma due to deficiencies found during the course of another inspection.

1.) 102416.5 (e) Staffing and Ratio Capacity

By licensees own admission, there were more than 8 children left in the supervision of a staff while licensee went to pick up children. According to licensee and assistant, this happened occasionally and not all the time.

The Licensee was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights.


A NOTICE OF SITE VISIT WAS ISSUED AND IS TO BE POSTED IN A PROMINENT LOCATION AT THE FACILITY FOR THE NEXT 30 DAYS ALONG WITH A COPY OF ALL TYPE A DEFICIENCIES (LIC809D) CITED DURING THIS INSPECTION. A COPY OF ALL TYPE A DEFICIENCIES CITED DURING THIS INSPECTION MUST ALSO BE IMMEDIATELY (within 24 hours of the child’s next day in care) GIVEN TO THE PARENTS OF ALL CHILDREN ENROLLED IN THE CHILD CARE FACILITY AND ANY CHILDREN ENROLLED INTO THE CHILD CARE FACILITY OVER THE NEXT 12 MONTHS.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2023
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 2
Document Has Been Signed on 06/01/2023 05:11 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 06/01/2023 04:05 PM


Created By: Aman Sharma On 04/07/2023 at 03:00 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: BUBELLO FAMILY CHILD CARE
FACILITY NUMBER: 364845824

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/10/2023
Section Cited
CCR
102416.5(e)

1
2
3
4
5
6
7
Staffing Ratio and Capacity: (e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee agrees to submit a plan for how they will ensure they will stay in ratio, along with a memo of understanding the regulation, which was provided to licensee. This must be sent to licensing no later than the POC due date.
8
9
10
11
12
13
14
Licensee admitted to leaving assitant in charge of more than 8 children at one time on more than one occassion. This poses an immediate risk to the Health and Safety to persons in care.
****AMENDED REPORT: THE DEFICIENCY CITED ON THIS CASE MANAGEMENT REPORT WAS REMOVED AND CITED UNDER SUBSTANTIATED COMPLAINT DATED 04/19/23****
8
9
10
11
12
13
14
****AMENDED REPORT: THE DEFICIENCY CITED ON THIS CASE MANAGEMENT REPORT WAS REMOVED AND CITED UNDER SUBSTANTIATED COMPLAINT DATED 04/19/23****

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Kimberly Williams
LICENSING EVALUATOR NAME:Aman Sharma
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2