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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843283
Report Date: 06/24/2024
Date Signed: 06/24/2024 11:02:13 AM

Document Has Been Signed on 06/24/2024 11:02 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KENNEDY FAMILY CHILD CAREFACILITY NUMBER:
364843283
ADMINISTRATOR/
DIRECTOR:		KIYANA KENNEDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 675-4949
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 2DATE:
06/24/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Kiyana KennedyTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
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On 06/24/2024 at 8:45 AM, Licensing Program Analyst (LPA) Tiffanie Diep arrived at the facility to conduct an annual inspection. LPA toured inside and outside of the home, reviewed records, and observed and/or discussed the following:
  • Normal days and hours of operation are Monday through Friday from 6:00 AM to 6:30 PM.
  • Off-limits areas include: the bedroom and garage on the first floor, entire second floor, and backyard.
  • The facility was operating within the licensed capacity and appropriate ratios.
  • Appropriate supervision was provided during the inspection.
  • A working telephone was present with current number on file.
  • An appropriate fire extinguisher, smoke detector, and carbon monoxide detector were present and tested by Licensee Kiyana Kennedy during the inspection.
  • Fireplace was properly screened to prevent access by children in care.
  • All hazardous items were stored inaccessible to children.
  • Toxins were locked.
  • There are no weapons present in the home per Licensee. Licensee understands all firearms, weapons, and ammunition must be locked separately and made inaccessible to children in care according to Title 22 Regulations.
  • Stairs were not barricaded. LPA observed two school-age children (ages 6 and 10) present in the home with Licensee.
  • Verification of control of property on file (Rental/Lease Agreement).
  • Property Owner/Landlord Notification (LIC 9151) and Property Owner/Landlord Consent Form (LIC 9149) on file.

Continues on LIC 809-C
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2024
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KENNEDY FAMILY CHILD CARE
FACILITY NUMBER: 364843283
VISIT DATE: 06/24/2024
NARRATIVE
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Continued from LIC 809 (Page 2)
  • Facility sketches, Emergency Disaster Plan (LIC 610A), and Notification of Parents' Rights poster (PUB 394) were posted.
  • Preventive health and safety training was completed on 03/08/2015.
  • Pediatric CPR and first aid certification expires on 04/01/2025.
  • Mandated Reporter Training certificate expires on 07/14/2025.
  • Licensee confirmed there are no accessible bodies of water on the premises at this time. Licensee understands all bodies of water, including in-ground and above-ground pools, hot tubs, spas, and ponds, must be inaccessible to children in care and be properly covered or fenced according to Title 22 Regulations. The Department must be notified prior to installation of these and similar bodies of water.
  • Clean, safe, and age-appropriate toys were present.
  • A current roster of children was on file.
  • Documentation of fire and disaster drills was on file; last drill was conducted on 03/25/2024.
  • Children’s records were complete.
  • Staff records were complete. LPA observed pediatric CPR and first aid certification for Licensee's parent/assistant (S2) expired on 01/20/2024. S2 was not present during the inspection. LPA discussed the requirement to renew CPR and first aid certification every two years prior to expiration and informed Licensee that certifications are to be approved by EMSA if S2 will be left alone with day care children.
  • Licensee was informed of their reporting requirements and was provided with the Regional Office’s Unusual Incident Reporting e-mail at [email protected].
  • Licensee can submit transfer forms to associate new individuals or to disassociate someone from their facility via e-mail to [email protected].
  • The Duty Officer is available to answer questions Monday through Friday from 8:00 AM to 5:00 PM at (951) 782-4200.
  • Resident and/or staff records reviewed during today’s inspection indicate that all adults who require caregiver background checks have received all required clearances or exemptions.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KENNEDY FAMILY CHILD CARE
FACILITY NUMBER: 364843283
VISIT DATE: 06/24/2024
NARRATIVE
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Continued from LIC 809-C (Page 3)

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of five days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensee 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. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at https://www.ada.gov/resources/child-care-centers/.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KENNEDY FAMILY CHILD CARE
FACILITY NUMBER: 364843283
VISIT DATE: 06/24/2024
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Continued from LIC 809-C (Page 4)

To improve the quality and value of the new inspection process, a survey may be sent to the e-mail address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE Tool, please send e-mail inquiries to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

There were no deficiencies cited at this time. See attached LIC 9102 for advisory note. An exit interview was conducted and report was reviewed with the licensee, Kiyana Kennedy. During the exit interview, Licensee confirmed that there are no registered sex offenders (RSO) living in the facility and LPA completed the RSO profile in the Field Automation System. A notice of site visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5