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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618928
Report Date: 04/09/2024
Date Signed: 04/09/2024 12:30:47 PM


Document Has Been Signed on 04/09/2024 12:30 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:ACOSTA, MICHELLEFACILITY NUMBER:
343618928
ADMINISTRATOR:ACOSTA, MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 419-3263
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:14CENSUS: 5DATE:
04/09/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Michelle AcostaTIME COMPLETED:
12:45 PM
NARRATIVE
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On Tuesday, 9 April, 2024, at approximately 10:05am, Licensing Program Analysts (LPAs) Fabian Schwartz and Matthew Gallo met with Licensee, Michelle Acosta, for the purpose of an unannounced annual inspection. Upon arrival, LPA observed licensee supervising 5 children. All individuals subject to criminal background review have obtained a criminal record clearance. LPA observed proper ratio and capacity was being followed. Facility hours of operation are Monday through Friday, 8:30 AM to 12:00 PM. LPAs verified that the annual fees are current.

A health and safety evaluation was conducted in all areas accessible to children. Off-limit areas include: Entire Upstairs, Kitchen, Family Room, Living Room, Dining Room, and Garage. Licensee acknowledged that children may never enter these off-limit areas. LPA observed that the facility is clean, safe, sanitary, and in good repair. LPA 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. LPA observed that there are no bodies of water at the facility. The backyard is fenced.

LPA observed a shed in the backyard that with an unengaged padlock on the latch. Upon inspection of the shed interior, LPA observed an open gun safe, where an unassembled firearm was present. Loose ammunition was further observed in the interior of the shed. Licensee states that firearm and ammunition belonged to their deceased husband, and that they were unaware of their presence. During visit, firearm was moved to a locked area of the home, and the lock to the shed was engaged to keep the ammunition locked separately.

LPA reviewed 5 children’s files which were observed to be complete. Required postings were seen in children's playroom by sliding door and the children’s roster was observed. Licensee’s CPR/First Aid card expires 10 June 25. Licensee’s Mandated Reporter certificate expires 5 June 25. Licensee understands that trainings must be completed every two years.

PAGE 1. REPORT CONTINUES ON LIC809-C
SUPERVISOR'S NAME: Amanda BlesiTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Fabian SchwartzTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4


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: ACOSTA, MICHELLE
FACILITY NUMBER: 343618928
VISIT DATE: 04/09/2024
NARRATIVE
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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.

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.

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.

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.

Report continues on 809-C
SUPERVISOR'S NAME: Amanda BlesiTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Fabian SchwartzTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
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: ACOSTA, MICHELLE
FACILITY NUMBER: 343618928
VISIT DATE: 04/09/2024
NARRATIVE
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A Type A Title 22 Deficiency is cited on the accompanying LIC809-D regarding the storage of firearms and ammunition.

Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians 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 receipt whenever any Type A documents are provided by the licensee. LIC 9224 was provided.

An immediate civil penalty of $500 is assessed for not meeting regulations regarding the storage of firearms. See LIC421IM.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee. During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Appeal Rights were provided.

SUPERVISOR'S NAME: Amanda BlesiTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Fabian SchwartzTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 04/09/2024 12:30 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: ACOSTA, MICHELLE
FACILITY NUMBER: 343618928

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)(A)
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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above due to LPA observation of an unlocked shed in the backyard containing an open firearm safe. A unassembled firearm was inside the safe, and unlocked boxed ammunition was also present in the shed. This poses an immediate health, safety, or personal rights risk to persons in care.
POC Due Date: 04/10/2024
Plan of Correction
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With LPA present, the licensee moved the unassembled firearm to a separate locked area of the home, and the lock to the shed where ammunition remains stored was engaged. Licensee intends to remove the firearm and ammunition, which belonged to their deceased husband, from the property.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Amanda BlesiTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Fabian SchwartzTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4