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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618933
Report Date: 05/09/2019
Date Signed: 05/09/2019 01:52:27 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:DUPRE, MILANIFACILITY NUMBER:
343618933
ADMINISTRATOR:DUPRE, MILANIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 419-9552
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:14CENSUS: 6DATE:
05/09/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Milani Dupre, LicenseeTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Joleen Kenney and Tanya Washington conducted a case management in response to information that was obtained during an unrelated investigation. It was reported to LPA Kenney that child #1 went missing for two hours when walking to meet the day-care provider at the meeting location from school. When the child failed to arrive at the meeting location at the gate, the Licensee contacted the school and parent of the child but failed to notify Community Care Licensing of the incident. The Licensee stated that she did not realize that this incident was an incident that had to be reported to the licensing office. The law enforcement authorities were also notified of the missing child. The child was located safely by the Licensee's assistant and law enforcement spoke with the child and then the child returned to the day-care facility.

A Type B deficiency is cited on the following page for failing to report the incident to Community Care Licensing.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen KenneyTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
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: DUPRE, MILANI
FACILITY NUMBER: 343618933
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/16/2019
Section Cited
CCR
102416.2(b)
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Reporting Requirements. The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home. This requirement is not being met as evidenced by: The Licensee did not report
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The Licensee stated that the child left the school grounds after school and did not meet up with the Licensee at the meeting spot to walk home to the day-care home. The Licensee stated that she was not aware of the requirements to report an incident that involved a child that had went missing from school and not her day-care. The Licensee stated that
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the incident that occurred on 4/12/2019 when child #1 did not meet the Licensee at the school gate to return to the day-care home. The child was located approximately two hours later and law enforcement had been notified.

This is a potential health and safety risk to children in care.
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she will report incidents as required. The Licensee agrees to submit an Unusual Incident Report (LIC624) to Community Care Licensing by the due date of 5/16/2019.
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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: Joleen KenneyTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
LIC809 (FAS) - (06/04)
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