093617085-8-15-2024-03-CC-SMAX-D86SV7-20240815141217

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093617085
Report Date: 08/15/2024
Date Signed: 08/15/2024 02:12:23 PM

Document Has Been Signed on 08/15/2024 02:12 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	BUTCHER, JOANNE		FACILITY NUMBER:	093617085
ADMINISTRATOR:	BUTCHER, JOANNE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 721-2029
CITY:	SOUTH LAKE TAHOE	STATE: CA	ZIP CODE:	96150
CAPACITY:	14	CENSUS: 3	DATE:	08/15/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Joanne Butcher		TIME COMPLETED:	02:35 PM

NARRATIVE

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On 08/15/2024, Licensing Program Analyst (LPA) Soleil Marx met with Licensee, Joanne Butcher, for an unannounced annual inspection. During the inspection there was a census of three children in care being supervised by the licensee. All individuals subject to criminal background review have obtained a criminal record clearance. Facilities hours of operation are Monday through Friday 08:00 AM to 05:00 PM.

The off-limits areas include: upstairs, laundry room, downstairs bedroom, deck and shed. Licensee understands that children may never enter off-limits areas.

A health and safety inspection was conducted in the areas accessible to children.LPA observed a working telephone, functioning smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher within the home. LPA observed fireplace and stairs within the home are properly barricaded to meet regulations. LPA observed main day care areas/rooms in the home were safe, orderly, and free of hazards. LPA observed a variety of age-appropriate toys within the home. Licensee stated there are no firearms or bodies of water on the premises. Licensee understands that if there are any poisons in the home, all poisons must be locked with a key lock or combination lock.

LPA observed at the time of inspection that the children's toilet flushing mechanism was not functioning. Licensee stated it recently stopped working, but that the toilet can still be flushed using buckets of water.

LPA observed all required postings, a children's roster and fire drill log, the last fire drill was conducted 08/2024. LPAs reviewed records of children’s files and staff files, all which contained the required documentation. Licensee has EMSA approved pediatric CPR/First Aid training, which expired 07/2024. Licensee has receipt of enrollment for CPR 09/2024. Licensee has current Mandated Reporter Training, which expires 07/2026. Licensee understands both CPR and mandated reporter training's’ must be completed every two years.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil Marx	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BUTCHER, JOANNE	FACILITY NUMBER: 093617085
	VISIT DATE: 08/15/2024

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LPA verified Licensee is aware of and practicing all safe sleep regulations and documentation.

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-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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 PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

One type B Title 22 deficiency was cited based on today’s inspection.

During the exit interview, the licensee, Joanne Butcher, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the licensee, Joanne Butcher. A notice of site visit was given and must remain posted for 30 days. Appeal Rights Provided.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil Marx	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/15/2024 02:12 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BUTCHER, JOANNE	FACILITY NUMBER: 093617085
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above by having an inoperable flushing mechanism on the children's toilet, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/15/2024
	Plan of Correction
1 2 3 4	Licensee will call a plumber to fix the toilet so the flushing mechanism is back operational. Licensee will send proof to LPA Marx by POC due date.

Section Cited

Personal Rights


	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: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil Marx	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

LIC809 (FAS) - (06/04)

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