053620868-11-29-2022-53-CC-TDIP-CLN2GK-20221129162316

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 053620868
Report Date: 11/29/2022
Date Signed: 11/29/2022 04:23:28 PM

Document Has Been Signed on 11/29/2022 04:23 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:	FERGUSON, REBECCA		FACILITY NUMBER:	053620868
ADMINISTRATOR:	REBECCA FERGUSON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 728-5010
CITY:	ANGELS CAMP	STATE: CA	ZIP CODE:	95222
CAPACITY:	14	CENSUS: 7	DATE:	11/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Rebecca Ferguson		TIME COMPLETED:	04:30 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 11/29/2022 at 1:30 PM, Licensing Program Analysts (LPAs) Tiffanie Diep and Arianna Manabat met with Licensee, Rebecca Ferguson, for the purpose of an unannounced annual inspection. There were seven children present at the time of inspection. Licensee's operating hours are Monday through Friday from 7:00 AM to 4:30 PM. 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. A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include all bedrooms on the first floor, the entire second floor, garage, and attic. LPAs observed stairs to the second floor barricaded by a baby gate. LPAs observed the required postings and a working phone. 2A10BC fire extinguisher meets regulations. LPAs observed smoke and carbon monoxide detectors and verified they were both functional. LPAs toured the kitchen area and verified knives were inaccessible to children in care. LPAs observed playroom area with age-appropriate toys for children. LPAs observed a bathroom and verified that hazardous and toxic items were inaccessible to children in care. LPAs observed a fireplace that was barricaded by a metal screen. Licensee stated there are weapons in the home. LPAs verified that weapons and ammunition were stored in separate locked safes. There are no bodies of water on the premises. Outdoor play space is fenced. Continues on 809-C

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Tiffanie Diep	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

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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Document Has Been Signed on 11/29/2022 04:23 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: FERGUSON, REBECCA	FACILITY NUMBER: 053620868
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. 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 as Licensee's certification expired on 02/12/2020 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/29/2022
	Plan of Correction
1 2 3 4	LPA reminded Licensee of mandated reporting requirements. Licensee stated they will provide proof of Mandated Reporter Training to LPA by 12/29/2022.

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: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Tiffanie Diep	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

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: FERGUSON, REBECCA	FACILITY NUMBER: 053620868
	VISIT DATE: 11/29/2022

NARRATIVE

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Children's files were reviewed. Emergency information and required immunization records were on file. LPAs observed a current roster and documentation that a fire drill is conducted at least once every six months. Licensee's immunization records are available in the facility file. Current EMSA pediatric CPR and First Aid certification was verified and expires 01/2023. Child Care Provider Mandated Reporter certification was discussed and expired 02/12/2022. Licensee was reminded to renew the course every two years.

LPAs 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. LPAs 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. LPAs discussed the requirement to check and log infant napping every 15 minutes for infants 24 months and under. LPAs provided a copy of the LIC 9227, Individual Sleeping Plan, for infants under 12 months.

This provider is currently providing Incidental Medical Services (IMS) to children in care. LPA reviewed storage of medication, and child personnel records.

For IMS information, see PIN 22-02-CCP. 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

Continues on 809-C

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Tiffanie Diep	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

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: FERGUSON, REBECCA	FACILITY NUMBER: 053620868
	VISIT DATE: 11/29/2022

NARRATIVE

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive e-mail communication. Licensee was encouraged to visit the Department’s website at http://ccld.ca.gov/ for information regarding child care updates, forms, regulations and legislation pertaining to Family Child Care Homes.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by e-mail 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.

An exit interview was conducted and report was reviewed with the licensee, Rebecca Ferguson. A copy of the report was provided to the licensee. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Tiffanie Diep	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

LIC809 (FAS) - (06/04)

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