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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103909038
Report Date: 04/19/2021
Date Signed: 04/19/2021 10:39:35 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:BROWN, DARYLMIKA FAMILY CHILD CAREFACILITY NUMBER:
103909038
ADMINISTRATOR:BROWN, DARYLMIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 940-3270
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:14CENSUS: 7DATE:
04/19/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Darylmika Brown - LicenseeTIME COMPLETED:
11:15 AM
NARRATIVE
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On 4/19/21, Licensing Program Analyst (LPA) Joseph Pacheco conducted an unannounced case management inspection. LPA met with Licensee to discuss Community Care Licensing (CCL) regulations. LPA discussed the purpose of the inspection with Licensee and obtained a census. Based on a review of Children’s files and the Children’s Roster it was determined that Licensee is not maintaining children’s files in accordance with Title 22 regulations. LPA also observed an LIC9040 Children’s Roster that was not up to date.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found (see LIC809-D):

LPA provided Licensee with a copy of Appeal Rights. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit Form is required to be posted for 30 days.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021
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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BROWN, DARYLMIKA FAMILY CHILD CARE
FACILITY NUMBER: 103909038
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/26/2021
Section Cited

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Operation of a Family Child Care Home. All homes shall have a current roster of the children. This requirement was not met, as evidenced by records review. LPA observed that the LIC 9040 Children’s Roster was missing the names of eight children.
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This is a potential risk to the health, safety or personal rights of children in care.
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Type B
04/26/2021
Section Cited

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Child’s Records.(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). (1) The licensee shall keep the signed and dated notice form for at least three years following termination of service to the child.
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This requirement was not met as evidenced by Licensee stating to LPA that she does not keep children’s paperwork once they’re no longer enrolled. This is a potential risk to the health, safety or personal rights 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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2021
LIC809 (FAS) - (06/04)
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