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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846215
Report Date: 01/20/2023
Date Signed: 01/23/2023 10:50:36 AM

Document Has Been Signed on 01/23/2023 10:50 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:CANFIELD FAMILY CHILD CAREFACILITY NUMBER:
364846215
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
01/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Haley Canfield, LicenseeTIME COMPLETED:
10:50 AM
NARRATIVE
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Licensing Program Analysts (LPA) Kay Turner arrived at the facility for the purpose of delivering investigation findings for complaint #09-CC-20221024124822. During the course of the investigation, the licensee noted having an assistant caring for the children enrolled at the facility. LPA Turner confirmed with the assistant of the care they provided at the facility, which included being left alone to supervise the children. Although the assistant confirmed being fingerprinted, the licensee did not ensure that that a criminal background clearance was submitted on behalf of the licensee's facility.

CCR 102370 (d)(1) states: all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: obtain a California clearance or a criminal record exemption as required by the Department.

See LIC 809D for deficiency. An immediate Civil Penalty was assessed.

Exit interview was conducted with Haley Canfield, licensee. A copy of this report, Notice of Site Visit, and Appeal Rights were provided A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Karrene Turner
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2023
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 01/23/2023 10:50 AM - It Cannot Be Edited


Created By: Karrene Turner On 01/20/2023 at 03:42 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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: CANFIELD FAMILY CHILD CARE
FACILITY NUMBER: 364846215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/24/2023
Section Cited
CCR
102370(d)(1)

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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption as required by the Department
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Licensee agrees to submit the livescan paperwork for the assistant, Kim Canfield to the LPA by the POC due date.
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Licensee reported having her mother, Kim Canfield, provide assistance with caring for the children, without securing her criminal background clearance.
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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:Aaron Ross
LICENSING EVALUATOR NAME:Karrene Turner
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023


LIC809 (FAS) - (06/04)
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