073402173-12-12-2023-02-CC-ILOA-CYG36J-20231212165825

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073402173
Report Date: 12/12/2023
Date Signed: 12/12/2023 04:58:35 PM

Document Has Been Signed on 12/12/2023 04:58 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	SIMS-CARR, KISA		FACILITY NUMBER:	073402173
ADMINISTRATOR:	SIMS-CARR, KISA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 222-2266
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94806
CAPACITY:	14	CENSUS: 6	DATE:	12/12/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Kisa Sims-Carr		TIME COMPLETED:	05:10 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 December 12, 2023 at 2:15pm, Licensing Program Analysts (LPAs) Indira Loza and Janai McClain met with Licensee Kisa Sims-Carr for an Unannounced Required Triannual inspection. Present during the inspection were the Licensee, her fingerprint cleared husband, minor daughter, 3 infants, 3 preschoolers, and one non-fingerprint cleared adult, Shakyna Russell. The home was toured for a health and safety inspection. The facility operates from 6:30AM – 5PM Monday through Friday. At approximately 2:16pm LPAs observed Shakyna Russell present at the facility. Shakyna has been employed at the daycare for approximately two months. Shakyna Russell does not have a fingerprint clearance, which violates Health and Safety Code of Regulation (HSC) 1596.871(c)(1)(A). This is a Type A violation and carries a civil penalty of $500. There were also two Type B deficiencies cited during today's visit. See LIC809-D for deficiencies. Due to time constraints the annual inspection will be continued at a later date. Deficiencies were reviewed with Licensee. Licensee confirmed she understands the Plan of Corrections. Exit Interview conducted. Appeal Rights, Notice of Site visit, and report provided to Licensee Kisa Sims-Carr.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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 12/12/2023 04:58 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SIMS-CARR, KISA	FACILITY NUMBER: 073402173
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

HSC

1596.871(c)(1)(A)

Administration of Child Day Care Licensing

Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above due to the Licensee's Assistant, Shakyna Russell, not having a fingerprint clearance which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 12/13/2023
	Plan of Correction
1 2 3 4	Shkyna Russell shall leave the daycare and the Licensee shall ensure that Shakyna Russell obtains a criminal clearance before being present in the childcare facility. The LPA will return to verify that Shakyna Russell either has a Clearance or is not present in the facility.

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: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/12/2023 04:58 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SIMS-CARR, KISA	FACILITY NUMBER: 073402173
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in 3 out of 3 infants did not have a sleep log on file which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/12/2024
	Plan of Correction
1 2 3 4	The Licensee shall email the LPA a copy of 5 consecutive days of Infant sleep logs which document the following: The provider shall physically check on the infant every 15 minutes. The provider shall check and document the following: Signs of distress which includes but is not limited to flushed skin color, increase in body temperature and restlessness, and Labored breathing. The logs shall be emailed no later than January 12, 2024.

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in that a facility roster was not updated which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/12/2024
	Plan of Correction
1 2 3 4	The Licensee shall email the LPA a copy of a current roster no later than January 12, 2024.

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: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC809 (FAS) - (06/04)

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