343618108-8-20-2024-03-CC-TWAN-D8BRXA-20240820132425

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343618108
Report Date: 08/20/2024
Date Signed: 08/20/2024 02:14:34 PM

Document Has Been Signed on 08/20/2024 02:14 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	PERDOMO, ANA		FACILITY NUMBER:	343618108
ADMINISTRATOR:	PERDOMO, ANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 332-9405
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95842
CAPACITY:	14	CENSUS: 3	DATE:	08/20/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Ana Perdomo		TIME COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On Tuesday, August 20, 2024 at 12:15 PM, Licensing Program Analyst (LPA) Tanya Washington met with Licensee, Ana Perdomo for the purpose of an unannounced required 3 year inspection. Upon arrival LPA observed Licensee providing care and supervision to three daycare children. There were no other adults present in the home during the inspection. All individuals subject to criminal background review have obtained a criminal record clearance. Facility hours of operation are seven days a week, 24 hours a day. Licensee stated that currently she does not provide overnight care. A health and safety evaluation was conducted in all areas accessible to children. Off-limit areas include: entire second floor, garage, two sheds in the backyard and two bedrooms/ bathroom with a separate entry. Licensee acknowledged that children may never enter these off-limit areas. Licensee indicated that she mainly utilizes the kitchen area, backyard and the playroom. LPA observed that the facility is clean, safe, sanitary, and in good repair. LPAs observed a functioning smoke detector, carbon monoxide detector, and a full 2A10BC fire extinguisher. The facility has adequate toys that appear to be safe for children to use. The licensee stated there are no weapons or poisons in the home. The fireplace located in the living room is screened and not used during day care hours. There are no bodies of water on the premises. LPA reviewed four children’s files which were observed to be complete. Required postings and the children’s roster were observed. LPA observed that a fire drill log was updated April 18, 2024. Licensee’s CPR/First Aid card expires 05/2025. Licensee did not have a current Mandated Reporter certificate. Licensee is reminded that both CPR and First Aid as well as Mandated Reporter Training must be renewed once every two years. LPA verified that the annual fees are current. Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. *PAGE 1. REPORT CONTINUES ON LIC809-C*

SUPERVISOR'S NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PERDOMO, ANA	FACILITY NUMBER: 343618108
	VISIT DATE: 08/20/2024

NARRATIVE

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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 licensee 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. LPAs observed a safe sleep log for an infant under two years old.

Licensee understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the day. Licensee understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report/LIC 624 shall be submitted within 7 days to remain in compliance. Licensee understands that if any structural changes are made to the home; licensing must be notified PRIOR to construction. Licensee understands that if she wants to make any changes to OFF-limit areas to an ON-limit area, she must notify licensing and LPA must do an inspection BEFORE children are allowed in said area. Licensee understands that children’s records are to be maintained according to Title 22 regulations and be accessible to licensing for up to 3 years.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Page 2. REPORT CONTINUES ON LIC809C

SUPERVISOR'S NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PERDOMO, ANA	FACILITY NUMBER: 343618108
	VISIT DATE: 08/20/2024

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

A notice of site visit was given and must remain posted for 30 days. One Type B deficiency is cited on the following LIC809D based on today's inspection. Exit interview conducted and report was reviewed with the licensee. During the exit interview, the Licensee Ana Perdomo, confirmed that there are no Registered Sex Offenders living in the facility.

SUPERVISOR'S NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/20/2024 02:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PERDOMO, ANA	FACILITY NUMBER: 343618108
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	Based on interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Licensee did not have proof of current training.
	POC Due Date: 09/20/2024
	Plan of Correction
1 2 3 4	Licensee will take the training online at www.mandatedreporterca.com and provide proof of completion to LPA by POC date of 09/20/2024.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

LIC809 (FAS) - (06/04)

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