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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846139
Report Date: 01/26/2022
Date Signed: 01/26/2022 05:18:49 PM

Document Has Been Signed on 01/26/2022 05:18 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 CAREFACILITY NUMBER:
364846139
ADMINISTRATOR:KNOX, KARENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 800-9749
CITY:MENTONESTATE: CAZIP CODE:
92359
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
01/26/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Applicant, Karen KnoxTIME COMPLETED:
04:35 PM
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On 01/26/2022 at 02:30pm, an office conference was held at the Riverside Regional Office. Present in the conference was Applicant, Karen Knox; Licensing Program Manager (LPM), Kimberly Williams and Licensing Program Analysts (LPAs), Destinee Hogue and Karrene Phillips.

The conference was called to discuss the following areas of concern:
- Understanding licensed care and license-exempt care
- General compliance with Health & Safety Code and Title 22 Regulations
- Collaborating and establishing a relationship with the Department
- Conduct inimical

Applicant, Karen Knox has a pending application and is currently pending licensure. A prelicensing inspection was conducted on January 25, 2022 and the following corrections were identified prior to the Department reviewing and making a determination for licensure.
(1) 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. (Proof of key-lock installed on kitchen cabinet provided via picture)
(2) Knives, sharp utensils, scissors, and push pins located in kitchen and downstairs office drawers shall be made inaccessible. (Proof of magnetic lock installed on cabinets in the kitchen and downstairs office submitted via picture)
(3) Off limit garage door needs to be made inaccessible. (Proof of installed latch on garage door submitted via picture)
(4) Submit and post an updated LIC999-Facility Sketch for downstairs, upstairs, and outdoor area. (Applicant submitted an updated outdoor sketch, missing proof of first and second floor sketch posted at the facility)
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2022
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: 01/26/2022
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(5) Pink toy truck with loose screw needs to be repaired or removed from outdoor play area. (Proof of pink toy truck submitted via picture)
(6) Submit a written Incidental Medical Service (IMS) plan for child(ren) who require Epi-pen and other Incidental Medical Services. (IMS plan under review for completion)
(7) 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. (Proof of pool partially disassembled submitted via picture. Further verification needed)
(8) BBQ grill needs to be covered and propane tanks shall be detached from BBQ Grill. (Proof of BBQ grill covered and propane tank removed from BBQ grill submitted via picture)
(9) Trampoline shall be made inaccessible to children. Trampoline zipper fencing is broken and not in working order. (Proof of zipped tied closed fencing submitted via picture)
(10) Wood and accessible hazards on the side of the backyard shall be made inaccessible. (Proof of fencing installed on the side of the backyard submitted via picture)

A follow-up prelicensing inspection will be conducted to verify the corrections identified above are in compliance prior to the Department evaluation for a license.

On 01/18/2022, Applicant was advised that California Health and Safety Code Sections 1596.80 and 1597.54 require that you have a license to provide family child care.

Based on additional information obtained regarding the operation of unlicensed care, a Notice of Violation of Law (LIC195) is being issued during this conference. Applicant was advised that continuing to operate unlicensed will result in a civil penalty assessment of $200 per day. During this conference, it was discussed with Applicant that continuance to operate and provide unlicensed care will result in denial of the pending application. At the time of this conference, Applicant admitted she currently has four children from three different families in care, as of today (January 26, 2022).

Applicant was advised that all information discussed during this conference will be reviewed with the Department's legal consultant for advisement and evaluation of an application denial.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
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: 01/26/2022
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Applicant was previously provided with Title 22 Regulations, 102357-Operation Without a License and 102358-License Exemptions and during this conference, the following Title 22 Regulations and Health & Safety Codes (H&S) were discussed and provided to Applicant: H&S Code 1597.54-Application for License, 102357-Operation Without a License, 102358-License Exemptions, 102393-Unlicensed Facility Penalties, and 102402-Revocation or Suspension of a License or Registration.

Applicant was advised to visit the Department's Resources for Parents and Providers-Family Child Care Provider Training video website at: https://ccld.childcarevideos.org/family-child-care-providers/. Applicant was advised to review Family Child Care Provider videos related to: Understanding licensed care and license-exempt care and Is Family Child Care the Right Business for Me? Family Child Care Provider video website link was provided to the Applicant during this conference. Applicant agrees to submit a statement acknowledging the Family Child Care Provider training videos were reviewed. Statement is due by 02/02/2022.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
LIC809 (FAS) - (06/04)
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