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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005145
Report Date: 05/16/2019
Date Signed: 05/16/2019 03:50:22 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:WIGGINS, LA TANYAFACILITY NUMBER:
214005145
ADMINISTRATOR:WIGGINS, LA TANYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 879-1304
CITY:MARIN CITYSTATE: CAZIP CODE:
94965
CAPACITY:14CENSUS: 5DATE:
05/16/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Laquisa AllenTIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Van performed an unannounced random annual inspection at the above facility. LPA met with licensee's helper Laquisa Allen, the purpose of the inspection was explained. Present at the home are licensee's helper ,5 children in care, and a 10 years old grandson of licensee. Licensee came home while LPA was reviewing required forms that were posted. The facility is operating within licensed capacity and within ratio on this day. LPA inspects inside of the facility for health and safety hazards. Hours of operations are Monday – Friday from 7:00AM – 6:00PM. Daycare areas are: living room, and office room. Off Limit areas are: kitchen, backyard and the entire second floor. Licensee states that sick children will be separated from the group and will be waiting in the office space for parents to pick up.

LPA observed three dogs, all three dogs were in the cages. Licensee stated that the dogs were normally outside in the yard, due to the rain the dogs stayed indoor. LPA did not observe any bodies of water on the facility. Per licensee there are no firearms or weapons in the home. Stair leading to the off limit area is barricaded. Cleaning supplies and chemicals are inaccessible to children. The home is equipped with a carbon monoxide detector, a smoke detector, and a fully charged fire extinguisher that meets minimum size requirements. The home is in well repair. There are sufficient amounts of age appropriate furniture, toys and reading materials available to children. There are an adequate lightning, ventilation, and comfortable temperature in the home.
Continue on the next page...............
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WIGGINS, LA TANYA
FACILITY NUMBER: 214005145
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2019
Section Cited
HSC
1597.622(a)(1)
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§1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions. (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.
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The licensee will send copies of proof of all completed immunizations for herself, and helper by May 31, 2019.
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This requirement is not met as evidenced by: The Licensee was unable to show proof of Immunizations for herself, and helpers Laquisa Allen.
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Type B
05/31/2019
Section Cited
CCR
102417(g)(9)(A)(1)
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102417 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 be limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. (1) The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.
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Licensee will conduct emergency disaster drills at least once every six months and keep a log. A sample form is given to Licensee as a reference today.
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This requirement is not met by review of records. The Licensee does not have proof that fire drills are being conducted and documented (at least one every six months. Not conducting fire drills could present immediate health and safety risks to the children.
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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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WIGGINS, LA TANYA
FACILITY NUMBER: 214005145
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2019
Section Cited
CCR
102418
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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.
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Licensee shall ensure all children's files have complete immunizations documented by 5/31/2019. A return licensing visit will be conducted to verify correction.
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This requirement is not met as evidence by review of children's files. C1, C4, and C5 do not have immunizations records. This is a potential health and safety risk.
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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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: WIGGINS, LA TANYA
FACILITY NUMBER: 214005145
VISIT DATE: 05/16/2019
NARRATIVE
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LPA reviewed children’s and staff’s files. Some children files had immunization records and signed parent’s rights notification forms. First Aid/CPR certification is presented. Licensee First Aid and CPR expired on 8/2018. LPA observes the last fire/earthquake drill was not logged. Discipline policy was discussed.Licensee states her discipline method will be talking to the child, redirection and finally ending with time-out. LPA reminds licensee that for time-out, one minute per child’s age, and no more than 5 minutes).

LPA reminds licensee that, as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles.

LPA reviews AB 1207 with the licensee. As of January 1, 2018, all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Deficiencies are cited on this day (see 809D). A copy of this report is reviewed with licensee, along with a notice of site visit which is to be posted for 30 days. Records to be maintained are explained to licensee. Licensee is informed for quarterly update on Licensing information, go to CCL website:
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4