304200697-2-6-2020-06-CC-GMAI-BLJPCA-20200206101138

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304200697
Report Date: 02/06/2020
Date Signed: 02/06/2020 10:11:47 AM

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:	KRAFT, DEBBIE		FACILITY NUMBER:	304200697
ADMINISTRATOR:	KRAFT, DEBBIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 639-6013
CITY:	ORANGE	STATE: CA	ZIP CODE:	92869
CAPACITY:	14	CENSUS: 5	DATE:	02/06/2020
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Debbie Kraft - Licensee		TIME COMPLETED:	10:45 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	Licensing Program Analyst (LPA) Mai conducted an unannounced case management inspection to ensure the health & safety standards as required by regulations governing family child care homes are met. LPA met with licensee, Debbie Kraft, and assistant, Tiffany Rickabaugh, caring for 5 children; which included 2 preschool age and 3 infants. Also present during inspection was licensee's husband. Licensee was operating within the licensed capacity as specified on license. A review of the Facility Personnel Report Summary on 02/05/2020 indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are 4 adults (including licensee) and one minor child living in the facility. Operating hours are 7:00 AM to 5:30 PM, Monday through Friday. On 01/23/2020 an unannounced annual visit was conducted, LPA requested to see Licensee’s pediatric CPR/First card, licensee stated the cards are posted on the wall near the front door. LPA went over to the front door to verify pediatric CPR/First aid expiration date and took a picture of Licensee’s and Assistant’s Pediatric CPR/Frist Aid cards; the cards have a date of issue 05/18 and expiration date of 05/20 from Mercy First Aid. On 02/04/2020, upon a closer inspection during an in-office review, LPA contacted Mercy First Aid and was unable to reach the agency whom provided the pediatric CPR/First training as the phone number listed on the card is no longer in service. Therefore, LPA contacted the Emergency Medical Services Authority (EMSA) on 02/05/2020 for clarification on the EMSA stickers issued on the licensee’s pediatric CPR/First Aid cards. The EMSA Program Analyst informed LPA the EMSA stickers (C161247, C161246, F214868, F214867) issued on licensee’s and her assistant’s cards were issued prior to the year 2015. The instructor for Mercy First Aid certification listed on the cards with the Emergency Medical Services Authority expired in March 2017, and there is no record the instructor has renewed his license with EMSA. Page 1 of 2.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gigi Mai	TELEPHONE: (714) 743-8565
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020

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 3

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: KRAFT, DEBBIE	FACILITY NUMBER: 304200697
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/06/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/07/2020 Section Cited	1 2 3 4 5 6 7	102416(c) Personnel Requirements. The Licensee...shall complete training on... pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	Based on record review and interview, Licensee failed to obtain current pediatric CPR/First aid issued either by a training program that has been approved by the Emergency Medical Services Authority. This poses an immediate safety risk to children in care.	8 9 10 11 12 13 14
Type A 02/07/2020 Section Cited	1 2 3 4 5 6 7	102402(a)(3) Conduct in the operation or maintenance of a family day care home which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on record review and interview, it was determined that the licensee was not forthcoming regarding her and her assistant's pediatric CPR/First Aid certification. This poses an immediate safety risk to children in care.	8 9 10 11 12 13 14

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 Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gigi Mai	TELEPHONE: (714) 743-8565
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: KRAFT, DEBBIE	FACILITY NUMBER: 304200697
	VISIT DATE: 02/06/2020

NARRATIVE

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On 02/06/2020, LPA Mai requested to see licensee’s original Pediatric CPR/First Aid cards and licensee was unable to provide original Pediatric CPR/First Aid cards for herself or assistant. Licensee stated she lost the original Pediatric CPR/First Aid card when she lost her wallet. LPA asked licensee when she last took the pediatric CPR/First Aid training, licensee stated it was few years ago with Instructor Wade, she could not recall this first name. Licensee was not forthcoming and provided contradictory statements regarding the pediatric CPR/First certification.

Based on LPA investigation, LPA has determined the Pediatric CPR/First Aid issue/expiration dates were altered and not current. LPA informed the licensee that she is being cited today for conducted inimical regarding the Pediatric CPR/First Aid cards and providing false statements.

The facility was not in compliance and violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: 102416(c) Personnel Requirements and 102402(a)(3) Revocation or Suspection of a License or Registration.

Due to the Type A violations cited today, the licensee shall post, and provide copies, of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days. LPA provided licensee with a hard copy of the LIC 9224.

An exit interview conducted with licensee in English. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door. End of Report. Page 2 of 2.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gigi Mai	TELEPHONE: (714) 743-8565
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020

LIC809 (FAS) - (06/04)

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