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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408856
Report Date: 07/27/2021
Date Signed: 07/27/2021 12:47:15 PM

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:EPPS, TRACYFACILITY NUMBER:
073408856
ADMINISTRATOR:EPPS, TRACYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(773) 719-1275
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY:14CENSUS: 6DATE:
07/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Tracy EppsTIME COMPLETED:
01:00 PM
NARRATIVE
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On 7/27/21 at 9:00 AM Licensing Program Analyst (LPAs) Michelle Sutton and Monica Mathur conducted an unannounced Annual inspection at Licensee Tracy Epps Family Childcare Home. LPAs met with Tracy Epps and explained the purpose of today's inspection. LPAs were granted the inspection authority to enter the Home. The family Childcare Home days and hours are Monday to Friday 8:00 AM to 6:00 PM. Present in the home at time of inspection were 4 infants and 2 preschool age. Licensee has a Large Family Child care home. During today's inspection no assistant was present. Licensing regulation states that when a helper is not present, a large family home has to follow ratio requirements of a small family home..Licensee is out of ratio today.

Indoor Space: At 9:15 AM A health and safety tour of inside the home was done. LPAs toured the premises with licensee. The home is sanitized and orderly in compliance with Title 22 Regulations at this time. There is a 2A10BC fire extinguisher, working smoke detectors and carbon monoxide detectors throughout the home. The home is a two story house consisting of 4 bedrooms, 3.5 bathrooms, living room, kitchen, separate dinning room, family room, in-law suite, laundry room and garage. The family room, in-law suite/bathroom, kitchen and backyard are used primary areas for day-care.The OFF-LIMIT areas are the downstairs bedroom located near the front door, the bathroom, near the front door, the entire upstairs which includes the master bedroom/bath, upstairs hall bathroom, 2 guest bedrooms and laundry room. These areas are inaccessible to children in care by closed and locked doors, visual supervision and a safety gate at the bottom of the stairs. There is a fish aquarium in the children play room which is inaccessible and out of reach from children. LPA is reminded licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes.The home maintains a working telephone.

Outdoor Space: AT 9:45 AM LPA toured the outdoor area (backyard) and observed it was fenced. LPA discussed with licensee that there needs to be supervision when children are outside playing. LPA observed an air conditioning unit that that is not fenced/covered and is accessible to children. There are no pools, hot tubs or other bodies of water.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
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 6
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: EPPS, TRACY
FACILITY NUMBER: 073408856
VISIT DATE: 07/27/2021
NARRATIVE
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Children files and Facility files were reviewed. Facility did not contain a Children's Roster, Licensee’s and assistant need to complete mandated reporter training. Licensee's CPR First Aid expired on 11/2020 and needs to complete pediatric CPR and first aid. No record of immunization against influenza, pertussis, measles and influenza vaccination verification for assistant. LPAs discussed the requirements of Facility files and employee files.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.

Licensee was reminded of the responsibility as a mandated reporter. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc. LPAs discussed the Guardian System. Licensee is registered for Quarterly Updates/PINs http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

At 12:00 PM In the areas that were evaluated, citation issued today for Staffing Ratio and Capacity.

Due to the issuance of a Type A citation during today's inspection, a copy of this Licensing Report must be posted in the facility and given to each existing parent by the end of today or next day child is in care. Report also has to be provided to the parent of children who are enrolled over the next 12 months. In addition, a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports must be signed by each parent and kept in each child's file.



Exit Interview was conducted with Tracy, where this report, citations were reviewed and discussed. Report was signed by Tracy confirming receipt of documents. A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE HOME FOR 30 CONSECUTIVE DAYS. APPEAL RIGHTS WERE GIVEN.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: EPPS, TRACY
FACILITY NUMBER: 073408856
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/28/2021
Section Cited

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102416.5(e) STAFFING RATIO AND CAPACITY: If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).This requirement is not met as evidenced by
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During today's inspection licensee had no assistant for child care. Licensee was alone with 4 infants and 2 preschool age children. This is an immediate risk to health and safety of children in care.
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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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2021
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: EPPS, TRACY
FACILITY NUMBER: 073408856
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/24/2021
Section Cited

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102416(c) PERSONNEL REQUIREMENTS: The licensee and other personnel as specified, shall complete
training on preventive health practices including pediatric CPR and first aid. .This requirement is not met as evidenced by
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Per LPAs observation and file review, licensee CPR and First Aid expired 11/2/2020. This is a potential risk to health and safety of children in care
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Type B
08/24/2021
Section Cited

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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 [...] and shall complete renewal mandated reporter training every
two years[...]. .This requirement is not met as evidenced by:
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Per LPAs observation and file review, licensee and assistant have no proof of current mandated reporter training. This is a potential risk to health and safety of children in care
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Assistant shall complete General and Childcare Providers sections. Licensee requires Child Care Providers certification only.
mandatedreporterca.com
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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2021
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: EPPS, TRACY
FACILITY NUMBER: 073408856
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/24/2021
Section Cited

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102417(g) OPERATION OF FAMILY CHILDCARE HOME: The home shall be free from defects or conditions which might endanger a child. [...] This requirement is not met as evidenced by
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LPA observered an AC unit in the backyard that did not have any fence/cover and was accessible to children. This is a potential risk to health and safety of children in care.
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Type B
08/24/2021
Section Cited

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102416.1(a) PERSONNEL RECORDS Personnel records shall be maintained on each employee [...] .This requirement is not met as evidenced by:
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Per LPAs observation and file review, licensee has no record of assistant file and paperwork. This is a potential risk to health and safety of children in care
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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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2021
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: EPPS, TRACY
FACILITY NUMBER: 073408856
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/24/2021
Section Cited

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1597.622(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
.This requirement is not met as
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Per LPAs observation and file review, licensee has no record of assistant immunizations and tB clearance. This is a potential risk to health and safety of children in care
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Type B
08/24/2021
Section Cited

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102425(j) The provider shall supervise infants while they are sleeping and adhere to the following requirements[...]
This requirement is met as evidence by
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LPAs file review shows no documentation of sleep log or LIC9227 in fant files age up to 12 months.
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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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2021
LIC809 (FAS) - (06/04)
Page: 6 of 6