045403207-11-22-2022-13-CC-JHEN-CLEVZW-20221122155325

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 045403207
Report Date: 11/22/2022
Date Signed: 11/22/2022 03:53:35 PM

Document Has Been Signed on 11/22/2022 03:53 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	FAY, KATHRYN FAMILY CHILD CARE HOME		FACILITY NUMBER:	045403207
ADMINISTRATOR:	FAY, KATHRYN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 228-9879
CITY:	CHICO	STATE: CA	ZIP CODE:	95928
CAPACITY:	12	CENSUS: 6	DATE:	11/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Kathryn Fay		TIME COMPLETED:	04:00 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	On 11/22/2022 at 2:35 PM, an annual inspection was made to the facility by Licensing Program Analyst (LPA), J. Helton. At 3:20 PM the home was toured inside and outside. The licensee was supervising 6 children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 8:15 AM to 4:30 PM, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are Master Bedroom and extra bedroom, garage, pantry, and were made inaccessible by child proof doorknob covers. The children use the back yard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed in the yard. 3 children's records were reviewed at 2:52 PM. 1 staff records were reviewed at 3:10 PM. There are currently 2 adults living in the home. The Licensee 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. Continued on LIC809C

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Jackie Helton	TELEPHONE: 530-513-0993
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: FAY, KATHRYN FAMILY CHILD CARE HOME	FACILITY NUMBER: 045403207
	VISIT DATE: 11/22/2022

NARRATIVE

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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 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

There were no deficiencies cited during today’s inspection.
Exit interview conducted and report was reviewed with the licensee Kathryn Fay.

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/process.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Jackie Helton	TELEPHONE: 530-513-0993
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/22/2022 03:53 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: FAY, KATHRYN FAMILY CHILD CARE HOME	FACILITY NUMBER: 045403207
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(c)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 2 child files which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/06/2022
	Plan of Correction
1 2 3 4	LIcensee will provide emailed copies of completed documents

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review], the licensee did not comply with the section cited above in 2 out off 2 children files which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/28/2022
	Plan of Correction
1 2 3 4	Licensee will immediatly begin documenting 15 minute sleep checks on all children up to 24 months.

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: Erin Virrueta	TELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Jackie Helton	TELEPHONE: 530-513-0993
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

LIC809 (FAS) - (06/04)

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