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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619111
Report Date: 05/03/2019
Date Signed: 05/03/2019 12:49:14 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:AUSTIN, YVONNEFACILITY NUMBER:
343619111
ADMINISTRATOR:AUSTIN, YVONNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 224-9655
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:14CENSUS: 5DATE:
05/03/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Yvonne AustinTIME COMPLETED:
12:55 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jeevun Birk-Miller and Licensing Program Manager (LPM) Sharon Ogbodo with the licensee Yvonne Austin, for the purpose of an unannounced annual random inspection. All individuals subject to criminal background review have obtained a criminal record clearance.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include the Master bedroom and garage. LPA observed the required postings, a working phone, 3A40BC fire extinguisher, and functioning smoke and carbon monoxide detectors. Licensee stated there are no weapons in the home. There are no bodies of water on the premises. Toxic and hazardous items are inaccessible to children. The fireplace in the home is appropriately barricaded to prevent access by children and outdoor play space is fenced.

Three children’s files were reviewed. Emergency information and required immunization records were on file. The licensee's immunization records for measles (MMR), pertussis (Tdap), and the flu are available in the facility file. Current in person EMSA CPR and First Aid certification was verified and expires 3/30/2021 and AB 1207 Mandated Reporter Training was not verified. The website for the Mandated Reporter Training is mandatedreporterca.com . Licensee stated she would ensure that her and her assistant will have the training completed.

This provider is currently not providing IMS services to children in care. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

Report continues on 809-C.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 263-1414
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019
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 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: AUSTIN, YVONNE
FACILITY NUMBER: 343619111
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/03/2019
Section Cited
HSC
1596.8662(b)(1)
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On or before March 30, 2018, a person who, on January 1, 2018, a licensed child 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
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Licensee agrees to take the training and have her assistances have the training completed and submit a copy of the completion certificate to licensing by 6/3/19.
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following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by: Based on record review the licensee failed to ensure that mandated reporter training was completed. This poses a potential health and safety risk to children in care.
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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: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 263-1414
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019
LIC809 (FAS) - (06/04)
Page: 3 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: AUSTIN, YVONNE
FACILITY NUMBER: 343619111
VISIT DATE: 05/03/2019
NARRATIVE
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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 verified the annual fees are current. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the licensee can request to be added to the distribution list to receive Quarterly Updates. LPA provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochures.

This facility evaluation report was reviewed and discussed with the licensee. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.



In the areas that were evaluated, the following Type-B deficiencies were cited under California Code of Regulation Title 22. Refer to the 809-D page of this report.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 263-1414
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3