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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845717
Report Date: 07/06/2022
Date Signed: 07/06/2022 01:53:09 PM

Document Has Been Signed on 07/06/2022 01:53 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:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
334845717
ADMINISTRATOR:TANYA JIMENEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 413-9276
CITY:CABAZONSTATE: CAZIP CODE:
92230
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 1DATE:
07/06/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:26 AM
MET WITH:Tanya JimenezTIME COMPLETED:
02:00 PM
NARRATIVE
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On this date and time, Licensing Program Analysts (LPAs) Aman Sharma, Laura Mejorado and Justin Giese conducted a case management inspection to ensure compliance with criminal record clearances for anyone residing, working or volunteering in the facility. Present during the inspection was Licensee, Tanya Jimenez and one child. Per Licensee they only care for their own relatives. During this inspection, LPAs toured the facility, took census, and checked criminal record clearances/exemptions and associations.

During today’s inspection three adults were found to be residing and/or have made contact with daycare children without having a criminal record clearance. A1 and A2 were found to be residing in the home from 7/3/22 -7/6/22. By Licensees own admission A3 has been in facility during daycare hours and is a registered sex offender.

LPAs discussed the following and provided a copy to Licensee: 102370.1 Criminal Record Exemptions and 102370 Criminal Record Clearance.

See LIC809D for deficiency cited per California Code of Regulations Title 22, Division 12. Licensee has been advised that due to the seriousness of the citation a revocation of license is probable.

An Non-Compliance Conference has been scheduled in the Riverside Office on 7/12/22 at 1pm.



Exit interview conducted and report was reviewed with the Licensee Tanya Jimenez.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224)]

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2022
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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Document Has Been Signed on 07/06/2022 01:53 PM - It Cannot Be Edited


Created By: Aman Sharma On 07/06/2022 at 12:34 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: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 334845717

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/07/2022
Section Cited
CCR
102370(d)(1)

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(d) 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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Immediately, Licensee agrees to have A1 and A2 fingerprinted and submit proof of a completed Livescan to CCL by the next business day on 07/07/2022.

Immediately, Licensee agrees to not have A3 reside or be present during daycare hours or have any interaction regular or routine contact with children in care. Licensee agrees to submit proof of where A3 resides and a written statement to CCL stating how they will ensure compliance with criminal record clearances/exemptions and ensure the health and safety of children in care.
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Based on review of records and Licensees own admission, A1 has been residing in the home since yesterday (7/5/22), A2 has been residing in the home since 7/3/22, and A3 is an RSO and was present in the home during daycare hours on 6/23/22 and 6/29/22 with no criminal record fingerprint clearance/exemption or association to the facility, which poses an immediate health, safety, and personal rights risk to children in care.
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Due to the seriousness of the citation an NCC has been scheduled in the Riverside Office on 7/12/22 at 1pm.

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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:Kimberly Williams
LICENSING EVALUATOR NAME:Aman Sharma
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2022


LIC809 (FAS) - (06/04)
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