343619021-11-7-2019-03-CC-KGOL-BHPT24-20191107132009

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343619021
Report Date: 11/07/2019
Date Signed: 11/07/2019 01:20:19 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:	QUINONES, MARIA		FACILITY NUMBER:	343619021
ADMINISTRATOR:	QUINONES, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 804-8400
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95838
CAPACITY:	14	CENSUS: 4	DATE:	11/07/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Maria Quinones		TIME COMPLETED:	01:45 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	Licensing Program Analyst (LPA) Goodell met with licensee, Maria Quinones, for the purpose of an unannounced Annual Inspection. Hours of operation are Monday- Thursday 5am-5:30pm. LPA observed 4 children present in the garage with assistant and licensee's husband. All individuals subject to criminal background review have obtained a criminal record clearance. LPA toured all areas accessible and pool located in the backyard that is fully fenced and self-latching gate. LPA observed napping area and children's restroom located in the home. Off-limits areas include master room and master bathroom. LPA verified current phone number and email. LPA observed fire extinguisher 3A40BC. LPA also observed smoke and carbon monoxide detectors. Licensee stated no weapons in the home. LPA observed poisons locked in cabinet inaccessible to children. Outdoor play space is fenced. Licensee acknowledged that 100% supervision is required in unfenced areas. Children's records were reviewed and observed at least seven files did not have Consent For Emergency Medical Treatment (LIC627), Parent Notification Additional Children in Care (LIC9150) and Affidavit Regarding Liability Insurance (LIC282). Due to files incomplete poses a potential risk to children in care. LPA observed fire drill log and Child Care Facility Roster (LIC9040) maintained. Preventative health training, current pediatric CPR and first aid certification was verified and expires 9/2021. Report continues on LIC809-C

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019

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: QUINONES, MARIA	FACILITY NUMBER: 343619021
	VISIT DATE: 11/07/2019

NARRATIVE

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Effective September 1, 2016, immunizations for adults providing care and supervision is required to be on file. LPA discussed the Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care facility must have vaccinations against, Pertussis, Measles and Influenza. LPA advised licensee that staff can sign a declaration to be exempt from the influenza vaccinations however; Pertussis and Measles are not exemptible. To be exempt from Pertussis and Measles staff must have a medical exemption signed by a licensed physician.

The Mandated Reporter Training was discussed. Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. In addition, effective January 1, 2018: Applicants must meet requirements as a precondition to licensure, existing licensees must meet requirements by March 30, 2018, new employees shall have 90 days from date of employment to complete training as required. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English. If no training is made available in a required person’s primary language, then that person shall be exempt from this requirement. Persons who would like to meet this requirement by using an alternate type of training other than the OCAP modules must first submit a request to their local Regional Office to obtain approval from the Department.

Current licensing fees were discussed and pin number was provided. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, forms, self-assessment guides, legislation and regulation information.

Title 22 Deficiencies cited on the attached LIC 809D. This facility evaluation report was reviewed and discussed with the licensee. Notice of Site Visit issued and must remain posted for 30 days.
Appeal Rights also issued and discussed.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: QUINONES, MARIA	FACILITY NUMBER: 343619021
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/07/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/06/2019 Section Cited	1 2 3 4 5 6 7	Employees or volunteers at family day care home; immunization requirements; records; exemptions Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination
	8 9 10 11 12 13 14	between August 1 and December 1 of each year. This requirement is not met due to proof licensee's and staff of immunization for Measles and Pertussis were not available during inspection which poses a potential risk to children in care.	8 9 10 11 12 13 14
Type B 12/06/2019 Section Cited	1 2 3 4 5 6 7	Child's Records. The licensee shall maintain, in each child’s record, a copy of the emergency information card required in Section 102417(g) (7). This requirement is not met due to LPA observed at least 7 children files incomplete which pose a potential safety concern.
	1 2 3 4 5 6 7

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: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019

LIC809 (FAS) - (06/04)

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