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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343610520
Report Date: 01/04/2022
Date Signed: 01/04/2022 03:49:06 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: 21DATE:
01/04/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Shanel Tate TIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Alize Tillery and Mai Lor arrived at the facility at 2:00pm to clear a deficiency cited on 12/15/2021. Upon arrival, LPAs used the call box to request entrance. Staff #1 answered the phone and responded that she was the only teacher in the room and would ask another teacher to open the door. LPAs waited to be greeted at the entrance for approximately 10 minutes prior to being met by Director Shanel Tate. LPAs observed two teachers and one aide with 10 infants, and 11 toddlers with one teacher during nap time.

LPAs observed that the facility was in Teacher-Child ratio and had fully qualified staff with aides supervising the children. LPAs cleared the deficiencies regarding Teacher-Child ratio. Director understands Teacher-Child ratio requirements and ensures it will be followed.

During the visit, at approximately 2:35pm, LPA Lor approached Staff #1 who appeared to be sleeping while supervising 11 toddlers during nap time. LPA observed three toddlers in the room awake while Staff #1's eyes were closed. When LPA asked Staff #1 if she did indeed fall asleep, Staff #1 responded that she didn't realize that she was asleep, but might have dozed off. Staff #1 stated this is a rare occasion and does not happen often. Based on LPA observation and staff interview, this is a lack of supervision and an immediate risk to children in care.

LPAs reminded Director to ensure infants are not restrained in toddler feeding tables, and that infants are to only be at the feeding tables when food is present. LPAs also requested that Director find a more sufficient way for parents and licensing to reach staff from the entrance. Director was reminded of the department's inspection authority.

A deficiency is cited on the 809D page. This report was reviewed, appeal rights were provided, as well as a Notice of Site Visit which shall remain posted for 30 days.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022
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 2
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: 01/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/18/2022
Section Cited

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(1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times.
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Based on observation and staff interview, this requirement was not met evidenced by: LPA observed Staff #1 sleeping while supervising napping toddlers. Staff #1 stated that she didn't realized that she was asleep, but might have dozed off.
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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: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2022
LIC809 (FAS) - (06/04)
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