214005145-4-21-2022-05-CC-HRCO-CDPUU7-20220421155151

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005145
Report Date: 04/21/2022
Date Signed: 04/21/2022 03:53:04 PM

Document Has Been Signed on 04/21/2022 03:53 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	WIGGINS, LA TANYA		FACILITY NUMBER:	214005145
ADMINISTRATOR:	WIGGINS, LA TANYA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 879-1304
CITY:	MARIN CITY	STATE: CA	ZIP CODE:	94965
CAPACITY:	14	CENSUS: 9	DATE:	04/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	La Tanya Wiggins		TIME COMPLETED:	02:15 PM

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	Licensing Program Analyst (LPA) Haydee Caliboso arrived at the facility at 11:45AM to conduct an unannounced annual inspection. LPA met with the Licensee, La Tanya Wiggins. Purpose of the inspection was explained. Present during the inspection were Licensee, 3 assistant helpers, 1 infant, 2 toddler age children, 5 preschool age child, 1 school age child. LPA observed that the facility is operating within ratio on this day. All adults have been fingerprinted clear. Hours of operation are: M-F, 7:30AM – 5:30PM. Licensee provides breakfast, snack, and lunch each day. The facility was inspected today, indoors and outdoors for health and safety hazards. Daycare areas: living room, 2^nd floor hallway bathroom only. Off Limit areas: Kitchen and the entire 2^nd floor of the home. LPA observed that off limit areas were properly locked and made inaccessible to the children in care. LPA observed carbon monoxide and smoke detector in the home are properly working. A fire extinguisher of size 2A10BC or bigger was also available in the home. First Aid kit is fully stocked and accessible. Per Licensee, there is no firearm or weapon in the home. Licensee stated there are no bodies of water and fireplace in the home. Per Licensee, there are no children in care who needs medications while in care. LPA observed that the house is in good repair, and free of hazards with proper temperature and ventilation. LPA observed that there are variety of age appropriate toys, books and other learning material available in the home for the children in care. Per Licensee, discipline policy is redirection or modeling about positive behavior. Cont. 809-C pg. 2

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

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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Document Has Been Signed on 04/21/2022 03:53 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
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: 04/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review at 1:00pm on 4/21/22, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/13/2022
	Plan of Correction
1 2 3 4	Licensee will submit a complete copy of immunization records for the 3 assistant helpers to LPA through email by 5/13/22.

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: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

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
	VISIT DATE: 04/21/2022

NARRATIVE

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All posting requirements are met and posted at the living room area. Licensee have First Aid CPR will expire 12/2023. LPA observed, emergency drill was last conducted on 1/2022 and properly logged. LPA reminded that emergency drill must be conducted at least once every six months, properly logged, and available upon request. All required posting documents are posted and visible. LPA reviewed child’s files during today’s inspection. LPA observed all files are complete and up-do-date. LPA observed facility has record of names, addresses and telephone numbers of each child’s authorized representative. Each child's record contains the record immunization. At 1:00pm, LPA observed 3 assistant helpers did not have immunization records in file. LPA reminded the Licensee that all adults and volunteers working with children are required to have immunization records before working with children.

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 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.
Cont. 809-C pg. 3

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

LIC809 (FAS) - (06/04)

Page: 3 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: 04/21/2022

NARRATIVE

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The Licensee was reminded about Mandated Reporter training available on the CCLD website. In addition to the AB1207 training must be completed every two years by all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. At 1:00pm, LPA observed 3 assistant helpers did not have a complete Mandated Reports in file.

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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

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 La Tanya Wiggins. Today’s report and notice of site visit will be sent to the Licensee by the end of the day on 4/21/22. Confirmation of receipt is required.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

LIC809 (FAS) - (06/04)

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