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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313616419
Report Date: 01/05/2022
Date Signed: 01/05/2022 03:11:59 PM

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:HAYDON, PATRICIAFACILITY NUMBER:
313616419
ADMINISTRATOR:HAYDON, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 223-1027
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:14CENSUS: 0DATE:
01/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Patricia Haydon - LicenseeTIME COMPLETED:
03:30 PM
NARRATIVE
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An unannounced annual/random inspection is made today by LPA Katrina Owens. Present at time of inspection were licensee; no children present. Facility was closed however licensee allowed LPA to conduct inspection.

A tour of the home, inside and outside, as shown on the facility sketch is conducted. Licensee states there are no weapons or firearms in the home. Swimming pool is fenced per Title -22 regulations. The swimming pool is also located behind wood fence in a separate yard inaccessible to children. LPA observed poisons, cleaning compound's, medications and other hazardous items are inaccessible to children. There is no fireplace. Fire extinguisher, Carbon Monoxide Detector and Smoke Detector meets regulations.
Currently, licensee does have 2 dogs that are inaccessible to children. The 2 goats and chickens are located in a pen, making the animals inaccessible to day care children.
There are no stairs in the home. Toys and play equipment that were observed appear to be safe. There is a working telephone. Children are supervised when outside in any unfenced play area. No infants under 12 months old present; no sleeping plans reviewed. No 15 minute logs to review, no infant present.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Licensee, Patricia Haydon, 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.

Pediatric CPR/FA is not current. A child roster is maintained. Fire and disaster drills are conducted every six months and documented. Some staff and children records reviewed.

Continued on next page
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: HAYDON, PATRICIA
FACILITY NUMBER: 313616419
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/05/2022

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
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Based on observation, the licensee did not comply with the section cited above in that she did not complete mandate reporter training.
POC Due Date: 02/04/2022
Plan of Correction
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Licensee states she will complete the mandated reporter training on or before the POC date 2/4/2022. At the website mandatedreporterca.com.

Licensee was informed if deficiency is not corrected by due date a civil penalty may be assessed.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above by not having a current CPR card.
POC Due Date: 02/04/2022
Plan of Correction
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Licensee stated she will complete and submit a current CPR card on or before the POC due date of 2/4/2022.
Licensee was informed if deficiency is not corrected by due date a civil penalty may be assessed.
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: Katrina OwensTELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:
DATE: 01/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2022
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: HAYDON, PATRICIA
FACILITY NUMBER: 313616419
VISIT DATE: 01/05/2022
NARRATIVE
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LPA observed proof that licensee and staff/ volunteers have met the requirements of SB 792.

LPA did not observed that all staff has completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com

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



Off-limit rooms are: 3 bedrooms, 2 bathrooms, backyard, Living Room, Kitchen/Dining room, Garage and Laundry Room. Licensee acknowledges that children may never enter these off-limit areas. Swing set observed and is anchored into ground. Observed tool shed in backyard and it locked by key lock.

During the exit interview, LPA discussed AB 633, Parent Notification Requirements, and the posting of licensing inspection notices and reports. Hours of operation are 8:45 AM to 11:45 AM; Monday thru Friday and other hours as arranged. Licensee states she does not transport children.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: see next page 809-D.
Appeal rights provided to licensee.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. Exit interview conducted and report was reviewed with the licensee, Patricia Haydon.
A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3