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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313609488
Report Date: 12/11/2019
Date Signed: 12/11/2019 10:33:48 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ROOT, NICHOLEFACILITY NUMBER:
313609488
ADMINISTRATOR:ROOT, NICHOLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 889-5508
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:14CENSUS: 8DATE:
12/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Nichole RootTIME COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Jeremey McClain and Lea Habtom met with licensee Nichole Root for an unannounced annual/random inspection. LPA observed a census of eight children, which included one infant and seven preschool age children. Licensee’s assistant Sarah was present today. Licensee stated there aren’t new residents in the home. All adult residents currently have criminal record clearances.

LPA toured areas of the home accessible to the children. The off-limit are the garage and the middle bedroom of the home.

LPA observed current CPR/First Aid certificate for licensee and assistant which expires 04/06/2021. LPA observed the following posted: a license, a Parents' Rights Poster and an Emergency Disaster Plan. LPA reviewed children's records for completeness, as well as the client roster. Licensee provided proof of immunizations for MMR, Pertussis, and influenza. LPAs did not observe assistants’ proof of immunizations of MMR and Pertussis but did have the declination of the influenza shot.

LPA discussed the Provider Information notice 19-08-CCP which discusses new immunization requirements from the Department of Public Health. LPA provided licensee with and updated CPDH 286 for recording children’s immunizations.

LPA observed that hazardous items (detergents, cleaning compounds, medication, sharp utensils, and other items that could pose a danger to children in care) are properly stored out of children's reach. LPA observed a fire place that was properly screened. There is a working telephone in the home. Licensee stated that there are no weapons in the home. Licensee’s fire extinguisher, carbon monoxide and smoke detector meet regulation. LPA observed fire drills documented on a calendar, indicating that the licensee is conducting disaster drills at least once every 6 months. Toys appear to be safe and in working order. The backyard is fenced. LPAs observed a hot tub that was locked properly. REPORT CONTINUED ON THE FOLLOWING PAGE.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: ROOT, NICHOLE
FACILITY NUMBER: 313609488
VISIT DATE: 12/11/2019
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed and the licensee is not currently providing IMS. 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

AB1207 Mandated Reporter training was observed to be current for licensee and her assistant. LPA provided Licensee with website: http://childcare.mandatedreporterca.com/ and reminded the licensee that the training must be completed once every two years.



LPA discussed recent changes in licensing requirements, Safe Sleep Regulations Concepts and provided licensee with Provider Information Notice. LPA also provided licensee with CDSS’ AB 2370 brochure regarding the effects of lead exposure. LPA provided the licensee with the Summer 2019 quarterly update from Childcare Advocates.

LPA also discussed Provider Information Notice regarding the recalls of Fisher-Price “Rock N’ Play Sleepers and Rocking Sleepers. LPA advised licensee that the products have been recalled due to a high amount of infant deaths, and advised licensee to immediately stop using the products.

Licensee provided LPA with their email for the purpose of being added to the Childcare Advocates distribution of quarterly newsletters.

Title 22 deficiencies are cited on the subsequent page of this report. If not corrected, these violations pose and immediate risk to the health and safety of children in care. Licensee acknowledges, that upon receipt TYPE A DEFICIENCIES, a LIC 9099-D with Type A deficiencies shall be posted for 30 days. Licensee also acknowledges that they must provide copies of this licensing report to parents/guardians of children in care and to parents/guardians of children newly enrolled at the facility during the next 12 months. LPA provided an LIC 9224, which must be signed by parents/guardians and kept with the children's files. Appeal Rights were provided.



This report was reviewed with licensee, and an exit interview was conducted. A Notice of Site Visit was provided and should remain posted for 30 days.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: ROOT, NICHOLE
FACILITY NUMBER: 313609488
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/11/2019
Section Cited

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Personal Rights.(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or
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authorization from the child's authorized representative. These rights include, but are not limited to, the following:(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement was not met as evidenced by LPA's observation of an ifant child (C1) sleeping in a Fisher Price Rock and Play Sleeper. Licensee stated that the child had been sleeping in the sleeper for approximately 30 minutes. This is considered an immediate risk to the health and safety of 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: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2019
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: ROOT, NICHOLE
FACILITY NUMBER: 313609488
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/31/2019
Section Cited

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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
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employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement was not met, as evidenced LPA's observation of licensee's assistant (S1) file. S1 did not have proof of MMR and Pertussis Immunizations. This is considered a potential risk to the health and safety of 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: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4