013414711-7-3-2019-02-CC-PDYR-BDQW5T-20190703165939

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013414711
Report Date: 07/03/2019
Date Signed: 07/03/2019 04:59:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	GILFORD, MARLENE		FACILITY NUMBER:	013414711
ADMINISTRATOR:	GILFORD, MARLENE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 533-0516
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94605
CAPACITY:	14	CENSUS: 6	DATE:	07/03/2019
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Marlene Gilford		TIME COMPLETED:	05:15 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	LPA Dyer and LPM Robinson conducted an unannounced complaint inspection to deliver the findings of the above allegation. Present were the licensee, 1 fingerprint cleared assistant, 1 infant, 4 preschool children and 1 school-age child. It was determined during the course of a complaint investigation received in the Oakland CCL office on 2/20/19 that the licensee violated a child's rights through the process of performing a personal examination of the child in 2011 or 2013. It was also determined that the licensee did not report an Unusual Incident where a suspected sexual abuse might have happened, but instead spoke to the victim’s parents. The attached Type A violations are cited today and must be corrected by the due date. These citations pose immediate Health and Safety risks to clients in care. Failure to correct violations will result in a civil penalty, and repeat violations will result in additional penalties. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing. Assembly Bill 633 Fact Sheet was given and discussed with the licensee. Failure to correct violations will result in a civil penalty, and repeat violations will result in additional penalties. Notice of site visit was posted at the time of the inspection and must be posted for 30 days. An exit interview was conducted. Appeal rights were given and discussed. This report must be available for public review for 3 years.

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2019

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GILFORD, MARLENE	FACILITY NUMBER: 013414711
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/03/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/04/2019 Section Cited CCR 102423(a)(1)(4)	1 2 3 4 5 6 7	Personal Rights. Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include.. (1) To be treated with dignity in his/her personal relationship with staff and other persons…(4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature…	1 2 3 4 5 6 7	Licensee will not complete personal examinations of children which violate their personal rights. She will contact the appropriate medical personnel or the police as a mandated reporter if examinations of children are required. Licensee will provide a statement as to how, in the future, she will proceed if physical examinations are required of her day care children.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by interview: licensee disclosed that she performed a personal exam on a child which violated the child’s personal rights. This poses an immediate health and safety risk to children in care.	8 9 10 11 12 13 14	Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected
Type A 07/04/2019 Section Cited CCR 102416.2(b)(3)(c)	1 2 3 4 5 6 7	Reporting Requirements: "A report shall be made to the Department...following the occurrence during the operation of a family day care home...Any unusual incident or child absence that threatens the physical or emotional health or safety of any child."	1 2 3 4 5 6 7	Licensee will complete and submit a report of the incident. In the future, Licensing will be contacted when Unusual Incidents occur per regulations. Copy of the Unusual Incident Form was given to the licensee to complete and return with 7 days.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by interview and record review: licensee did not make a report to CCL after a suspected child abuse incident. This poses an immediate health and safety risk to children in care.	8 9 10 11 12 13 14	Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2019

LIC809 (FAS) - (06/04)

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