033603744-3-3-2022-53-CC-ASRN-CC728D-20220303161010

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 033603744
Report Date: 03/03/2022
Date Signed: 03/03/2022 04:10:26 PM

Document Has Been Signed on 03/03/2022 04:10 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	MILLINGTON, JENNIFER		FACILITY NUMBER:	033603744
ADMINISTRATOR:	MILLINGTON, JENNIFER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 245-6927
CITY:	PLYMOUTH	STATE: CA	ZIP CODE:	95669
CAPACITY:	14	CENSUS: 10	DATE:	03/03/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Jennifer Millington		TIME COMPLETED:	04:15 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	At 1:20pm Licensing Program Analyst (LPA) Aruna Sridharan met with licensee Jennifer Millington and two assistants upon arrival at the facility. Licensee Jennifer Millington arrived 5 minutes later with two school aged children. LPA stated the visit today is for the purpose of unannounced annual inspection. The facility operates Monday through Friday from 7:00am to11:00pm. LPA toured all areas of the home that are accessible to the children. Today’s census was 8 children with 2 preschool aged children and 6 infants. Later 2 school aged children arrived. LPA observed that all adult residents residing have criminal record clearances. LPA advised licensee if anyone over the age of 18 years old in the home they must have a criminal record clearance as well. LPA observed posting of the license, Parent's Rights and the current disaster plan. Off-limit areas include backyard, shed, daughter's bedroom, laundry room and garage. Licensee acknowledged that children may never enter these off-limit areas. The backyard is fenced and licensee acknowledges that children may never be left unsupervised in an unfenced area of the yard. Licensee stated there are no weapons in the home and LPA observed a standing pool latched. The fireplace is barricaded. LPA observed that poisons are locked and that fire extinguisher, smoke detector and carbon monoxide detector meets regulation. Cleaning materials, hazardous items and medications are all inaccessible to children. There is a working telephone, toys appear to be in a safe condition and the home appears to be clean and orderly. LPA conducted file reviews and observed licensee and assistants have proof of immunizations. Licensee advised to have flue decline letter in staff files. LPA observed current CPR and First Aid certificates that expires on 12/2022. All the staff members including license did not have valid Mandated reporter certificates. LPA observed Fire Drill Log and current roster. LPA observed all 10 children's files and the required forms were duly signed by the authorized representative. Report continues on 809C....

SUPERVISOR'S NAME: Justin L Denton	TELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MILLINGTON, JENNIFER	FACILITY NUMBER: 033603744
	VISIT DATE: 03/03/2022

NARRATIVE

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ncidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA also discussed Unusual Incident Reports (UIRs) and reporting requirements. LPA informed the licensee that if any unusual incidents occur she must contact the Department within 24 hours and an UIR must be submitted with 7 days, describing the specifics to the incident.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee Jennifer Milington was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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.

Title 22 Deficiencies observed in the areas that were evaluated during today's inspection are documented on 809D page. LPA read this report to the licensee; she stated that understands today’s inspection. Exit interview conducted and report was reviewed with the licensee Jennifer Millington. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Justin L Denton	TELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/03/2022 04:10 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MILLINGTON, JENNIFER	FACILITY NUMBER: 033603744
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(d)(1)

Staffing Ratio and Capacity

(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants; or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in 6 infants out of 8 children, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/04/2022
	Plan of Correction
1 2 3 4	Licensee will ensure that she is following the capacity of infants in the daycare at all times by changing the infants schedules with parents.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Justin L Denton	TELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

LIC809 (FAS) - (06/04)

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