121371397-11-18-2022-13-CC-KLYH-CLAQPA-20221118112025

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 121371397
Report Date: 11/18/2022
Date Signed: 11/18/2022 11:20:35 AM

Document Has Been Signed on 11/18/2022 11:20 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	THOMAS, KAREN FAMILY CHILD CARE HOME		FACILITY NUMBER:	121371397
ADMINISTRATOR:	THOMAS, KAREN L.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 442-8052
CITY:	EUREKA	STATE: CA	ZIP CODE:	95501
CAPACITY:	14	CENSUS: 9	DATE:	11/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Karen Thomas		TIME COMPLETED:	11:30 AM

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 11/16/2022 at 8:45 AM, an annual inspection was made to the facility by Licensing Program Analyst (LPA) Kiriko Lynch. At 8:45 AM the home was toured inside and outside. The licensee and assistant were supervising 9 children and operating within the licensed capacity and ratio requirements. The facility’s operating hours are currently 8:30 AM – 5 PM, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are master bed/bath, additional bedroom, partial garage, and were made inaccessible by gates, locks. The children use the back yard as the main outdoor play area and it is fully fenced. The home utilizes forced air as heating. There were no pools or other bodies of water observed in the yard. Ten children’s files were reviewed at 9:30 AM. Two staff files were reviewed at 10 AM. The 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. LPA discussed the safe sleep regulations with the 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. LPA 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. See next page

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Kiriko Lynch	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: THOMAS, KAREN FAMILY CHILD CARE HOME	FACILITY NUMBER: 121371397
	VISIT DATE: 11/18/2022

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the licensee Karen Thomas.

See next page for Type B deficiency cited.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Kiriko Lynch	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 11/18/2022 11:20 AM - 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: THOMAS, KAREN FAMILY CHILD CARE HOME	FACILITY NUMBER: 121371397
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited


	Deficient Practice Statement
1 2 3 4	Cal. Code of Regulations, Title 22, Section 102418 Immunizations (g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. Type B - This requirement was not met as evidenced by the majority of children's files did not have immunity records.
	POC Due Date: 12/02/2022
	Plan of Correction
1 2 3 4	Licensee stated that she has been meaning to update her facility files, and she will ensure all children's records will have copies of their immunity records by the POC due date.

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: Erin Virrueta	TELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Kiriko Lynch	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

LIC809 (FAS) - (06/04)

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