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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 053613073
Report Date: 10/08/2019
Date Signed: 10/08/2019 11:18:51 AM

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:GARANT, MICHELLEFACILITY NUMBER:
053613073
ADMINISTRATOR:GARANT, MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 772-7267
CITY:VALLEY SPRINGSSTATE: CAZIP CODE:
95252
CAPACITY:14CENSUS: DATE:
10/08/2019
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Michelle Garant, LicenseeTIME COMPLETED:
12:00 PM
NARRATIVE
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Regional Manager (RM) Thomas Stahl, Licensing Program Manager (LPM) Jeanne Smith, and Licensing Program Analyst (LPA) Justin Denton met with Licensee Michelle Garant at the Sacramento South Regional Office. During the meeting, the following issue was discussed.

On 5/10/2019, the Department received an allegation that a day care child sustained serious injuries due to being bitten by the licensee's dog in the backyard of the family care home on 05/09/2019. The child's parents sought medical attention for the child’s injuries.

The Department did not receive either a verbal incident report within 24 hours or a written incident report within 7 days. Both are required under Health and Safety Code Section 1597.467 to remain in compliance. This will be cited under Title 22 Section 102216.2: Reporting Requirements.

SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019
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 2
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: GARANT, MICHELLE
FACILITY NUMBER: 053613073
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/01/2019
Section Cited

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Reporting Requirements: The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home.
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Licensee did not report an incident where her dog bit a day care child at her home and the child received medical treatment.
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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: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2019
LIC809 (FAS) - (06/04)
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