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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343610520
Report Date: 03/10/2022
Date Signed: 03/10/2022 11:12:42 AM


Document Has Been Signed on 03/10/2022 11:12 AM - 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: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: 15DATE:
03/10/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Shanel TateTIME COMPLETED:
11:30 AM
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On March 10, 2022, approximately at 10:05 AM, Licensing Program Analysts (LPAs) Tanya Washington and Kelly Ferrara met with Facility Representative Shanel Tate to conduct a case management- plan of correction inspection to clear previously cited deficiencies which were issued on 02/07/2022.

During today's inspection LPAs observed eight infants in the "Baby" room supervised by two staff and seven toddlers on the playground supervised by two staff.

LPAs are clearing Type A citations for ratios and infants sleeping in rockers.

LPAs reviewed files for staff present on 02/07/2022 and the files were still incomplete, LPAs are issuing a civil penalty in the amount of $300.00 dollars for failure to correct the violation for incomplete files/ missing ECE transcripts for staff. LPAs did not observe Early Childhood Education units, shot records, AB1207 Mandated Reporter Training or LIC503- Health Screening Report for Facility Personnel.

LPA provided Facility Representative with form LIC311A which specifies documents required for staff. LPA will return after 04/08/2022 to review staff files to ensure the facility is in compliance with record keeping.

Notice of site visit posted and appeal rights are provided. This report was reviewed and discussed with Facility Representative Shanel Tate.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2022
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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