364846139-1-25-2022-09-CC-DHOE-CB23DH-20220125170931

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364846139
Report Date: 01/25/2022
Date Signed: 01/25/2022 05:10:04 PM

Document Has Been Signed on 01/25/2022 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:	KNOX FAMILY CHILD CARE		FACILITY NUMBER:	364846139
ADMINISTRATOR:	KNOX, KAREN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 800-9749
CITY:	MENTONE	STATE: CA	ZIP CODE:	92359
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 2	DATE:	01/25/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Applicant, Karen Knox		TIME COMPLETED:	03:20 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	On 01/25/2022 at 12:00pm, Licensing Program Manager (LPM) Kimberly Williams and Licensing Program Analyst (LPA) Destinee Hogue arrived at the facility to conduct a pre-licensing inspection. The Applicant has applied for a Large Family Child Care Home and a fire clearance for a capacity of 14 children was obtained and approved on 11/02/2021. Present during this inspection was: Applicant, Karen Knox, Adult resident Zachary Deuel, Applicant's minor children, and two children from the same family. LPM and LPA toured the facility, inside and out and the following was observed and/or discussed: Normal days and hours of operation are: Monday through Friday, 5:00am to 7:00pm OFF-LIMIT AREAS INCLUDE: Garage, Entire second floor, above ground pool, and entire back yard During this inspection, LPM and LPA reviewed COVID-19 guidance and resources with Applicant and advised Applicant to stay up to date with COVID-19 restrictions and guidance by checking the California Department of Public Health website; local health department website (San Bernardino County Public Health Department); and Community Care Licensing Division, Provider Information Notices (PIN). · Appropriate fire extinguisher, smoke detector and carbon monoxide detector are present and were tested by the applicant during this inspection. Fire extinguisher, smoke detector and carbon monoxide detector are in working order. · All hazardous items were not made inaccessible. See list of corrections on LIC809-C · No guns or weapons present as of this date. Applicant understands all guns, weapons and ammunition must be key-locked separately and made inaccessible per Title 22 Regulations. · Staircases are barricaded · Outdoor and Indoor fireplace is properly screened · Storage of poisons and toxins are inaccessible to children; however, poisons and toxins were not stored behind key-lock. See list of corrections on LIC809-C

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2022

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: KNOX FAMILY CHILD CARE	FACILITY NUMBER: 364846139
	VISIT DATE: 01/25/2022

NARRATIVE

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· Copy of control of property on file
· Facility Sketch and Emergency Disaster Plan are posted. See list of corrections on LIC809-C
· Health & Safety Certificate including Lead Poisoning Prevention completed on 08/22/2021
· Pediatric CPR and First Aid Card expires 08/21/2023
· Mandated Reporter Training completed on 10/29/2021 and expires 10/29/2023
· There is an above pool surrounded by wood fencing; however, above ground pool does not have a cover and above ground pool siding is approximately 4 feet and 7 inches in height and is currently not in compliance with Title 22 Regulations. Applicant understands all bodies of water including ponds, above ground pools and spas, in-ground pools and 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.
· Clean, safe and age appropriate toys.
· There are no toxic plants observed at this time

· The Applicant was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: [email protected]
· The Applicant can submit transfer forms to associate new individuals or to disassociate someone from your facility at: [email protected]

The following was discussed with the Applicant:
- Pre-Licensing Visit Packet provided (children’s/staff records & posting requirements included)
- 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
- 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 with the licensing office at all times
- Baby walkers, bouncy seats, exer-saucers and other similar items are prohibited
- LPM and LPA discussed the Safe Sleep Regulations with Applicant, Karen Knox and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2022

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: KNOX FAMILY CHILD CARE	FACILITY NUMBER: 364846139
	VISIT DATE: 01/25/2022

NARRATIVE

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- LPM and LPA also informed Applicant, Karen Knox of the importance of checking for recalled devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/https://www.cpsc.gov/Recalls and recommended the Applicant register's with the CPSC to be notified of any recalls on their purchased equipment.

- 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

- Applicant was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

- Go to the licensing webpage www.cdss.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.

- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at (951)782-4200

Before licensure, the following needs to be corrected/completed:
(1) Applicant agrees to participate in office conference prior to licensure. Office Conference is scheduled for January 26, 2022 at 2:30pm.
(2) Poisons, toxins, and flammable Chafing Dish-Fuel Gel stored under kitchen sink and cabinet located in day care room must be stored behind a key-lock.
(3) Knives, sharp utensils, scissors, and push pins located in kitchen and downstairs office drawers shall be made inaccessible.
(4) Off limit garage door needs to be made inaccessible.
(5) Submit and post an updated LIC999-Facility Sketch for downstairs, upstairs, and outdoor area

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2022

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: KNOX FAMILY CHILD CARE	FACILITY NUMBER: 364846139
	VISIT DATE: 01/25/2022

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(6) Pink toy truck with loose screw needs to be repaired or removed from outdoor play area.
(7) Submit a written Incidental Medical Service (IMS) plan for child(ren) who require Epi-pen and other Incidental Medical Services.
(8) Above ground pool is not in compliance with Title 22 Regulations. Pool does not have a cover, pool siding is 4 feet and 7 inches in height and does not meet five feet regulation requirement, bricks supporting pool are broken/cracked, and ladder and chairs stored in pool area shall be removed or made inaccessible.
(9) BBQ grill needs to be covered and propane tanks shall be detached from BBQ Grill.
(10) Trampoline shall be made inaccessible to children. Trampoline zipper fencing is broken and not in working order.
(11) Wood and accessible hazards on the side of the backyard shall be made inaccessible.

Once all corrections have been verified, the application for a Large Family Child Care Home will be submitted for approval with a maximum capacity of 12, or 14 with parent notification. Applicant advised that all corrections are due within 30 days or the application may be withdrawn. Corrections due by 02/25/2022.

The Applicant, Karen Knox confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

Exit interview conducted and report was reviewed with the Applicant, Karen Knox.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2022

LIC809 (FAS) - (06/04)

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