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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343610520
Report Date: 12/15/2021
Date Signed: 12/15/2021 03:34:15 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:POPPY PATCH-PHASE IIIFACILITY NUMBER:
343610520
ADMINISTRATOR:TATE, SHANELFACILITY TYPE:
830
ADDRESS:9638 BUTTERFIELD WAYTELEPHONE:
(916) 845-4949
CITY:SACRAMENTOSTATE: CAZIP CODE:
95827
CAPACITY:60CENSUS: DATE:
12/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Shanel TateTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alize Tillery met with Director Shanel Tate for the purpose of an unannounced annual random inspection. Director was reminded never to exceed the conditions, limitations and capacity specified on the license. Upon arrival, LPA observed 10 infant children supervised by 3 staff, and 10 toddler children supervised by 2 staff. Director was reminded of the Teacher to Child Ratio regulations. Facility hours of operation are Monday through Friday from 5:45 AM to 5:30 PM.

LPA toured all activity and classroom spaces (infant classrooms 1, 2 and the toddler classrooms 3 and 4) the kitchen area, the napping areas and the outdoor play area. LPA reminded Director that infants are to be placed in the crib once they fall asleep in the activity area, including being held or when in a rocking swing. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children; Director stated that there are no children’s medications in the facility at this time. Director stated there are no poisons on the premises. Furniture and equipment are in good condition. The toileting facility has one toilet (out of three) that is out of order. Director stated that DGS visited the facility two weeks ago and is still working on repairing the toilet. Director will keep LPA Tillery updated and Director was advised to submit an Unusual Incident Report. LPA observed four changing tables in arms reach of a sink. LPA observed infant food and bottles labeled in the refrigerator. The food preparation space is free of litter, all food was protected against contamination, and storage containers with solid waste have covers. The floors appeared to be clean throughout the facility, though Director was encouraged to deep clean the carpets.



Drinking water is readily available to children both indoors and outdoors. LPA observed a water pitcher and childrens personal cups LPA observed the electric sign in and sign out sheet, Program uses a tablet and app called ProCare, also used to communicate with parents. Playground equipment and surfaces are free of loose or sharp parts. There is rubber cushion beneath the playground equipment in the outdoor play area. There are sufficient equipment and toys. There are shaded areas supplied by the building.
Report continues on 809-C.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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: POPPY PATCH-PHASE III
FACILITY NUMBER: 343610520
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center 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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record view and interviews, the licensee did not comply with the section cited above in three staff members did not have their immunizations on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/07/2022
Plan of Correction
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Director will submit proof of staff immunizations by POC date.
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 record review and interview, the licensee did not comply with the section cited above in that three staff members did not have certificates on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/07/2022
Plan of Correction
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Director will submit proof of staff certificates by POC date.
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: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2021
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: POPPY PATCH-PHASE III
FACILITY NUMBER: 343610520
VISIT DATE: 12/15/2021
NARRATIVE
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Seven staff files and ten present day care children file records were reviewed. All children files were observed to be complete. LPA discussed and provided the Individual Sleep Plan form with Director. Director understands this form is to be in each infants file, that is 12 months and under. At least one staff member present today has current Pediatric CPR and First Aid certification. All staff currently employed with the facility have a criminal record clearance and are associated to the roster. LPA observed that three staff members are missing their immunization record and their Mandated Reporter training certificate. Director understands the mandated reporter training is to be taken every two years, for all staff. There are no firearms or bodies of water on the premises. LPA observed a smoke detector. Director is to follow up with DGS to confirm that there is a carbon monoxide detector in the facility. LPA reviewed the Department's inspection authority and discussed with designee any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within ten working days. LPA verified the annual fees are current.

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.



This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

Director was reminded that all adults 18 and over, 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 Child Care Center. 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.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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: POPPY PATCH-PHASE III
FACILITY NUMBER: 343610520
VISIT DATE: 12/15/2021
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director, Shanel Tate.

A deficiency is cited on the subsequent page of this report under the California Code of Regulations, Title 22. Director was provided a copy of the Appeal Rights (LIC9058) and Director's signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4