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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300608444
Report Date: 04/23/2019
Date Signed: 04/23/2019 03:40:28 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:BROWN, DIANNEFACILITY NUMBER:
300608444
ADMINISTRATOR:BROWN, DIANNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 778-3779
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:14CENSUS: 0DATE:
04/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Dianne Brown-LicenseeTIME COMPLETED:
04:00 PM
NARRATIVE
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An unannounced Annual/Random inspection of the facility was conducted by Licensing Program Analysts (LPA) Andrea Taylor and Gigi Mai toured areas of the home accessible to the children. No children were present during today's inspection. A review of family member/staff records on this date indicates that all family members and/or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA observed current EMSA approved CPR and First Aid certificates (exp:04/20), posted Parent's Rights and current disaster plan. Fireplace contains a screen. Fire extinguisher, and smoke detector meet regulations. All sharp utensils and cleaning products are stored up high and latched or locked which are inaccessible to children in care. Fire drill log was observed. Medications are stored up high and inaccessible to children in care. Toys and outdoor play equipment age appropriate for the ages served are located here. The backyard is fenced. LPA reminded the licensee that they must report any major changes or alterations to Licensing Office.

No Immunization records (Measles, Pertussis, and Influenza) and no Mandated Reporter Training Certificates on file for licensee.


The carbon monoxide alarm did not work during today's inspection.

One child’s file was reviewed. Notification of parents’ rights, Parent notification additional children in care, Identification and Emergency information, Consent for emergency medical treatment.

Licensee was reminded that licensee shall be present at facility and ensure that children in care are supervised at all times. Licensee must make sure that a substitute adult cares for the children when licensee is temporarily absent. The licensee was also reminded that no child shall be left alone in a parked vehicle at any time.

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2820
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: BROWN, DIANNE
FACILITY NUMBER: 300608444
VISIT DATE: 04/23/2019
NARRATIVE
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In the areas that were evaluated the facility was not in compliance of the California Code of Regulations, Title 22, Division 12, Section 1597.543, 1597.622, 1596.8662(b)(1) is being cited on the attached LIC 809D.

Exit interview was conducted. The Notice of Site Visit was posted. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

Licensee was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov.

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the facility representative.
English: https//www.cdph.ca.gov/programs/SIDS/Doucments/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Doucments/ChildCareProvSleepSPAN2011.pdf

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials


· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold

AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2820
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2019
LIC809 (FAS) - (06/04)
Page: 2 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: BROWN, DIANNE
FACILITY NUMBER: 300608444
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/01/2019
Section Cited
HSC
1597.543
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1597.543 Carbon monoxide detectors required; inspection. Every family day care home for children shall have one...carbon monoxide detectors in the facility... the presence of these detectors during inspections. This requirement is not met as evidenced by:
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Licensee stated she will purchase carbon monoxide this weekend and submit the proof of purchase to LPA Taylor.

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Based on observation, the licensee failed to ensure carbon monoxide detector was working. This poses a potential Health and Safety risk to the children in care.
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Type B
05/23/2019
Section Cited
HSC
1597.622
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Immunization's. 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 stated she will get proof of immunizations. The licensee will send a copy of the immunization record to LPA by due date.
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The licensee did not have proof of immunization against influenza, measles or pertussis on file.
This poses a potential health and safety risk to 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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2820
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: BROWN, DIANNE
FACILITY NUMBER: 300608444
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2019
Section Cited
HSC
1596.8662(b)(1)
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Mandated Reporter Training: On or before March 30, 2018, a person who is a licensed child care provider, shall complete the mandated reporter training a), and shall complete renewal mandated reporter training every two years following the date on which the initial mandated reporter training. occurred
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Licensee states that she will complete the Mandated Reporter Training and send in verification to LPA fax at 714) 703-2831 or email to LPA.
andrea.taylor@dss.ca.com
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This requirement is not met as evidenced by a review of licensee's file which did not contain a copy of the Mandated Reporter Training Certificate. This poses a potential health and safety risk to the 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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2820
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4