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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617996
Report Date: 06/08/2021
Date Signed: 06/08/2021 03:13:09 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:SAULTER, THERESAFACILITY NUMBER:
343617996
ADMINISTRATOR:SAULTER, THERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 729-7102
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:14CENSUS: 10DATE:
06/08/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Theresa SaulterTIME COMPLETED:
03:20 PM
NARRATIVE
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Due to COVID-19 pandemic, Licensing Program Analyst (LPA) Mai Lor conducted a tele-inspection case management inspection via Facetime with licensee Theresa Saulter. Census included (# of children). During the course of a case management investigation, LPA Lor conducted interviews with parents and witnesses, and received text messages that confirmed the licensee was using a baby walker for an infant. It was also confirmed that when the infant was napping in the bedroom separate from the room where the licensee was stationed, the door to the bedroom was closed. This poses an immediate health and safety risk to children in care.

Licensee was advised that baby walkers are not permitted in the facility. LPA Lor also advised the licensee that when she is not stationed in the same room where infants nap, the door to the room where infants nap shall remain open and ensure that safe sleep regulations for infants shall be followed and implemented. LPA Lor reviewed safe sleep regulations and safe sleep materials will be emailed to licensee.

See subsequent LIC 809 for deficiencies cited. Exit interview conducted.

Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021
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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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: SAULTER, THERESA
FACILITY NUMBER: 343617996
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/09/2021
Section Cited

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A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Section 1596.846(b) and (c).
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Based on interviews and documents, the licensee permitted and utilized a baby walker in the facility. This poses an immediate health and safety risk to children in care.
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Type A
06/09/2021
Section Cited

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If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.
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Based on interviews, the licensee failed to leave the door to the bedroom where the infant was napping open. This poses an immediate health and safety risk to children in care.
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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: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2021
LIC809 (FAS) - (06/04)
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