313615176-4-19-2022-03-CC-JMCN-CDMTM3-20220419145029

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313615176
Report Date: 04/19/2022
Date Signed: 04/19/2022 02:50:39 PM

Document Has Been Signed on 04/19/2022 02:50 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	CUNNINGHAM, ROBIN		FACILITY NUMBER:	313615176
ADMINISTRATOR:	CUNNINGHAM, ROBIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 906-2890
CITY:	AUBURN	STATE: CA	ZIP CODE:	95603
CAPACITY:	14	CENSUS:	DATE:	04/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Robin Cunningham		TIME COMPLETED:	03:00 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	On April 19, 2022 Licensing Program Analyst (LPAS) Jeremey McClain met with Licensee Robin Cunningham for an unannounced annual inspection. At, 1:05 pm LPAs observed a census of 2 children, which included 2 preschool age children. At 2:00 pm licensee picked up 2 more school age children .Licensee stated there aren’t new residents in the home. All adult residents have criminal record clearances. LPAs toured areas of the home accessible to the children. The off-limit areas of the home are: two locked sheds and side yard. LPAs observed current CPR/First Aid certificate which expires 03/2024. LPAs observed the following posted: a license, a Parents' Rights Poster and an Emergency Disaster Plan. LPAs observed that licensee does not current completion of AB1207 Mandated Reporter training. LPAs provided Licensee with website: http://childcare.mandatedreporterca.com/ and reminded the licensee that the training must be completed once every two years. LPAs reviewed children's records for completeness, as well as the client roster. LPAs observed records of immunizations for MMR, Pertussis, and influenza/ influenza declination. During the interior and exterior inspection: LPAS 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. LPAs observed a fireplace that was baricadded by a gate. There are no weapons in the home. LPAs observed a fire extinguisher which was last serviced once a year. Carbon monoxide and smoke detectors were tested and observed to be functional. LPAS observed fire drills documented on a calendar, indicating that the licensee is conducting disaster drills at least once every 6 months. Equipment and furnishings in areas where children are active appeared to be safe and in working order. LPAs did not observe a pool/pond/body of water. . REPORT CONTINUED ON THE FOLLOWING PAGE.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClain	TELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022

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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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: CUNNINGHAM, ROBIN	FACILITY NUMBER: 313615176
	VISIT DATE: 04/19/2022

NARRATIVE

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This facility does not currently provide Incidental Medical Services- IMS. 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.

Deficiency was observed during today’s inspection and are cited on the following page of this report.

This report was reviewed with licensee, and an exit interview was conducted.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClain	TELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/19/2022 02:50 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: CUNNINGHAM, ROBIN	FACILITY NUMBER: 313615176
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above with updating the mandated reporter training every two years which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/19/2022
	Plan of Correction
1 2 3 4	Licensee agreed to send a copy via email of the updated mandated reporter training to LPA L. Habtom.

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: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClain	TELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022

LIC809 (FAS) - (06/04)

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