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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619359
Report Date: 06/14/2019
Date Signed: 06/14/2019 08:24:50 AM

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:EDWARDS, MIRIAMFACILITY NUMBER:
343619359
ADMINISTRATOR:EDWARDS, MIRIAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 698-4213
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:14CENSUS: 8DATE:
06/14/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Miriam EdwardsTIME COMPLETED:
08:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility for a Plan of Correction inspection regarding the deficiency cited on LIC809D dated 6/7/19 regarding staffing ratio and capacity. LPA met with Miriam Edwards, also present was licensee’s assistant. Present at time of inspection were eight children placing the facility in compliance with Title 22 regulations and the Health and Safety Code. Based upon today’s inspection, LPA observed that the deficiency is cleared as of today. Approximately at 7:30 am on arrival LPA observed an infant sleeping in a Baby Rocker, this is a personal rights violation and considered as an immediate risk to the children in care. Licensee stated that she did not know that infants could not sleep in Baby Rockers and that she will no longer allow babies to sleep in them.

Title 22 Deficiencies have been cited on the attached LIC 809D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's files
This report was reviewed and discussed with licensee. A notice of site visit and appeal rights were provided.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2019
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: EDWARDS, MIRIAM
FACILITY NUMBER: 343619359
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/15/2019
Section Cited
CCR
102423(a)(2)
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To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This is not met by evidence: LPA observed an infant sleeping in a Baby Rocker. This is considered a immediate risk to the children in care.
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Licensee stated that she did not know that it was a personal rights violation for babies to sleep in Baby Rockers and that she will no longer allow Babies to sleep in them. Licensee removed the baby from the rocker. LPA cleared the deficiency.
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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: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2019
LIC809 (FAS) - (06/04)
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