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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618597
Report Date: 10/18/2022
Date Signed: 10/18/2022 12:33:45 PM


Document Has Been Signed on 10/18/2022 12:33 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:PATTERSON, LORRAINE & HERNANDEZ, LORRAINEFACILITY NUMBER:
343618597
ADMINISTRATOR:PATTERSON, LORRAINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 952-8622
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY:14CENSUS: 3DATE:
10/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Lorraine Patterson and Lorraine HernandezTIME COMPLETED:
12:45 PM
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On 10/18/22 Licensing Program Analyst (LPA) Fabiola Diaz met with licensees Lorraine Patterson and Lorraine Hernandez for an unannounced annual/1 year inspection. During the inspection there were 3 daycare children present, one being licensees' own child. All individuals subject to criminal background review have obtained a criminal record clearance.

The home is a two story home with a front yard, 4 bedrooms, 3 bathrooms, kitchen, living room, dining room, lunch room, garage, play room, laundry room, and a fenced backyard. The off-limit areas are: entire second floor, garage, laundry room, downstairs bedroom, and sides of backyard. Licensees were notified that prior to any changes of an on-limit to an off-limit area, or vice versa, the department must be notified. LPA observed the fire place to be screened. LPA observed 3 out of 3 flight of stairs not barricaded. If standing in the Lunch Room, one long flight of stairs leads up to the second floor, a short flight of stairs leads down to the playroom, and another short flight of stairs leads down to the living room. During the inspection, licensees placed a barricade on the stairs that lead up to the second floor, and a removable accordion gate at the bottom of the stairs by the playroom. Licensees explained they will be sending photos to LPA when the top of both of the short flight of stairs are barricaded. (Note: Licensees explained they will not place a barricade at the bottom of the short stairs leading to the living room, since day care children only use this flight of stairs to access the bathroom and/or backyard. Licensees stated children under 5 years old will be escorted at all times to and from the bathroom and/or backyard. Licensees understand that if the children under 5 years of age use the living room, licensees will need to barricade the bottom of these stairs.)

Report continues on 809C...............
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022
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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Document Has Been Signed on 10/18/2022 12:33 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833


FACILITY NAME: PATTERSON, LORRAINE & HERNANDEZ, LORRAINE
FACILITY NUMBER: 343618597

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. On today's date 10/18/22, licensees did not provide proof of a working Carbon Monoxide detector in the facility.
POC Due Date: 10/19/2022
Plan of Correction
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Licensees stated they will purchase a Carbon Monoxide detector. Licensees will send a video to LPA to show proof of a working Carbon Monoxide in the facility.
Type A
Section Cited
CCR
102417(g)(3)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Licensees did not ensure to have a barricade on 3 out of 3 flight of stairs.
POC Due Date: 10/19/2022
Plan of Correction
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On today's date, licensees placed a barricade on the stairs that lead up to the second floor and a removable accordion gate at the bottom of the stairs by the playroom. Licensees will send photos to LPA showing that the top of both of the short flight of stairs are barricaded. (Note: Licensees will not barricade the bottom of the short stairs leading to the living room).

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: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022
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: PATTERSON, LORRAINE & HERNANDEZ, LORRAINE
FACILITY NUMBER: 343618597
VISIT DATE: 10/18/2022
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A health and safety inspection was conducted in the areas accessible to children. The house has a working telephone, fully charged fire extinguisher, and smoke detector that meet Title 22 regulations. LPA did not observe a Carbon Monoxide detector. Licensees stated there are no firearms on premises. LPA observed all the required postings. LPA advised licensees that if there are any poisons at the home, all poisons must be locked with a key lock or combination lock.

LPA discussed licensee's immunization records. LPA discussed maintaining a children's roster and a fire drill log. LPA observed the updated fire drill log. Licensee's CPR/First aid card had an expiration date of 12/14/23. Mandated Reporter Training for licensee was not observed. A technical advisory note was assessed. LPA provided licensee with an updated LIC311D. LPA did not observed the children's immunizations to be transferred to the CDPH 286 form. A technical advisory note was assessed.

Incidental Medical Services were discussed– IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm
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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: PATTERSON, LORRAINE & HERNANDEZ, LORRAINE
FACILITY NUMBER: 343618597
VISIT DATE: 10/18/2022
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Licensee was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit must remain posted for 30 days. Exit interview was conducted and report was reviewed with the licensees.


LPA Diaz informed licensees that this report dated 10/19/22 documents Type A citations which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Diaz informed the licensees to provide a copy of this licensing report dated 10/19/22 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022
LIC809 (FAS) - (06/04)
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