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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343610520
Report Date: 07/01/2022
Date Signed: 07/01/2022 02:07:39 PM


Document Has Been Signed on 07/01/2022 02:07 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: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: 12DATE:
07/01/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Esther GomezTIME COMPLETED:
02:15 PM
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Licensing Program Analysts (LPAs) Amanda Sutter and Alize Tillery met with teacher, Esther Gomez, for a case management inspection regarding deficiencies cited 5/13/2022. LPAs were able to contact the Director, Shanel Tate, on the phone. Purpose of the inspection was explained. Upon arrival to facility, LPAs observed 6 infants and 6 toddlers supervised by 4 staff.

Before arriving at the facility, LPAs observed that licensing fees had not been paid. During today's inspection, LPAs observed proof of 15 minute infant sleep checks as well as the individual infant sleeping plan. LPAs observed all toilets to be operable. At 12:25 PM, LPAs observed four cockroaches in the kitchen area and pantry. Director stated that they had requested from the Franchise Tax Board to have an exterminator come to the facility and that they had deep cleaned the facility. Director stated that she could not identify the carbon monoxide detector. LPAs observed two staff files to be missing the LIC503, one staff file to be missing the LIC508, one staff file to be missing the LIC9052, and one staff file to be missing the mandated reporter training.

Based on today's inspection, licensee failed to provide correction for three out of seven deficiencies 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.

Exit interview conducted and report was reviewed with facility representative Esther Gomez. Copy of this report was reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Amanda SutterTELEPHONE: (916) 261-8918
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2022
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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