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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
343621421
Report Date:
09/20/2023
Date Signed:
09/20/2023 07:29:08 PM
Document Has Been Signed on
09/20/2023 07:29 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:
DYER, MARY
FACILITY NUMBER:
343621421
ADMINISTRATOR:
DYER, MARY
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(916) 903-7674
CITY:
CITRUS HEIGHTS
STATE:
CA
ZIP CODE:
95610
CAPACITY:
14
CENSUS:
16
DATE:
09/20/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
03:30 PM
MET WITH:
Mary Dyer
TIME COMPLETED:
06:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Kyrsten Williams and Amanda Sutter conducted an unannounced annual inspection and met with the Licensee, Mary Dyer. LPAs observed 14 children in care with the licensee and the assistant. After about 4:30pm, multiple children left the facility. LPAs observed 4 children near the garage whom the LPAs had not seen before. The children stated they were in the garage. Based on the number of children that already left the facility, there were at least 16 children at the facility. Licensee was reminded to never exceed the capacity and limitations on her license. Facility hours of operation are Monday through Friday 6:00 AM - 6:00 PM. LPAs observed that the annual facility fees are current.
LPAs conducted a health and safety inspection and observed that the facility is clean, safe, sanitary, and in good repair with ventilation. LPAs observed the required documents were posted where visible to parents. LPAs observed hazardous items accessible to children including nails, unfenced tools, wired fence, lawn mower, and broken plastic poles. The fire extinguisher appeared to be in working condition and accessible. LPAs observed the smoke and carbon monoxide detectors are functioning. The facility has equipment and toys safe for children. The backyard is fenced, and the licensee acknowledged that in areas that are not fenced, 100% supervision is required. The licensee stated there are no weapons on the premises. LPAs did not observe any bodies of water on the premises. LPAs observed an electric fire place within living room furnishing that does not get hot to the touch. Off limit areas include: all bedrooms and garage. The licensee understands that children may never enter these off-limit areas.
LPAs observed a current children's roster. LPAs did not observe a current fire drill log or sleep check log. LPAs reviewed children’s files and observed they are incomplete. LPAs observed the CPR/First Aid certificate was current. LPAs observed a current Mandated Reporter certificate for the licensee. The licensee was reminded the Child Care portion must be completed every two years. Licensee stated she does not have a file for her assistant.
PAGE 1. REPORT CONTINUES ON LIC809-C
SUPERVISOR'S NAME:
Seychelle De Luca
TELEPHONE:
(916) 263-5719
LICENSING EVALUATOR NAME:
Kyrsten Williams
TELEPHONE:
(916) 413-0056
LICENSING EVALUATOR SIGNATURE:
DATE:
09/20/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/20/2023
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
8
Document Has Been Signed on
09/20/2023 07:29 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:
DYER, MARY
FACILITY NUMBER:
343621421
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/20/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.3(a)(6)
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following:
(6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.
This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation and interview, the licensee did not comply with the section cited above in four children stated they were in the garage, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
09/21/2023
Plan of Correction
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LPA will return to observe off-limit areas are not being used for child care.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
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:
Seychelle De Luca
TELEPHONE:
(916) 263-5719
LICENSING EVALUATOR NAME:
Kyrsten Williams
TELEPHONE:
(916) 413-0056
LICENSING EVALUATOR SIGNATURE:
DATE:
09/20/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/20/2023
LIC809
(FAS) - (06/04)
Page:
6
of
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Document Has Been Signed on
09/20/2023 07:29 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:
DYER, MARY
FACILITY NUMBER:
343621421
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/20/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)
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:
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 in hazardous items were found accessible to children including nails, unfenced tools, wired fence, lawn mower, and broken plastic poles, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
09/21/2023
Plan of Correction
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Licensee will remove all hazardous items accessible to children. LPA will return to complete observation.
Type A
Section Cited
CCR
102416.5(a)
Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.
This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation, the licensee did not comply with the section cited above in 16 children were observed in care, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
09/21/2023
Plan of Correction
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LPA will return to ensure proper capacity is being followed.
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:
Seychelle De Luca
TELEPHONE:
(916) 263-5719
LICENSING EVALUATOR NAME:
Kyrsten Williams
TELEPHONE:
(916) 413-0056
LICENSING EVALUATOR SIGNATURE:
DATE:
09/20/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/20/2023
LIC809
(FAS) - (06/04)
Page:
2
of
8
Document Has Been Signed on
09/20/2023 07:29 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:
DYER, MARY
FACILITY NUMBER:
343621421
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/20/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.
This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on record review, the licensee did not comply with the section cited above in there is no record of a fire drill being completed within the last six months, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
10/20/2023
Plan of Correction
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LPA will return to observe record of completed fire drill.
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:
Seychelle De Luca
TELEPHONE:
(916) 263-5719
LICENSING EVALUATOR NAME:
Kyrsten Williams
TELEPHONE:
(916) 413-0056
LICENSING EVALUATOR SIGNATURE:
DATE:
09/20/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/20/2023
LIC809
(FAS) - (06/04)
Page:
3
of
8
Document Has Been Signed on
09/20/2023 07:29 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:
DYER, MARY
FACILITY NUMBER:
343621421
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/20/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:
This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not have a file for the assistant, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
10/20/2023
Plan of Correction
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LPA will return to observe completed file for assistant.
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.
This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above in licensee does not have record of emergency information for multiple files or consent to emergency medical care for 4 of the 5 files reviewed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
10/20/2023
Plan of Correction
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4
LPA will return to observe completed childrens files.
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:
Seychelle De Luca
TELEPHONE:
(916) 263-5719
LICENSING EVALUATOR NAME:
Kyrsten Williams
TELEPHONE:
(916) 413-0056
LICENSING EVALUATOR SIGNATURE:
DATE:
09/20/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/20/2023
LIC809
(FAS) - (06/04)
Page:
4
of
8
Document Has Been Signed on
09/20/2023 07:29 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:
DYER, MARY
FACILITY NUMBER:
343621421
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/20/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in there is no documentation for 15 minute sleep checks, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
10/20/2023
Plan of Correction
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4
LPA will return to observe documetation of 15 minute sleep checks.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
Seychelle De Luca
TELEPHONE:
(916) 263-5719
LICENSING EVALUATOR NAME:
Kyrsten Williams
TELEPHONE:
(916) 413-0056
LICENSING EVALUATOR SIGNATURE:
DATE:
09/20/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/20/2023
LIC809
(FAS) - (06/04)
Page:
5
of
8
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:
DYER, MARY
FACILITY NUMBER:
343621421
VISIT DATE:
09/20/2023
NARRATIVE
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The 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.
During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.
LPAs discussed the safe sleep regulations with the 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/
.
The 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.
PAGE 2. REPORT CONTINUES ON LIC809-C
SUPERVISOR'S NAME:
Seychelle De Luca
TELEPHONE:
(916) 263-5719
LICENSING EVALUATOR NAME:
Kyrsten Williams
TELEPHONE:
(916) 413-0056
LICENSING EVALUATOR SIGNATURE:
DATE:
09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/20/2023
LIC809
(FAS) - (06/04)
Page:
8
of
8
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:
DYER, MARY
FACILITY NUMBER:
343621421
VISIT DATE:
09/20/2023
NARRATIVE
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5
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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
.
Deficiencies are cited on the subsequent page of this report (LIC809-D) under the California Code of Regulations, Title 22. The licensee was provided a copy of their Appeal Rights (LIC9058) and the licensee's signature on this form acknowledges receipt of these rights.
LPA Williams informed the licensee to provide a copy of this licensing report dated 09/20/2023 that documents three Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC9224), or other written statement, must be placed in the child's file for verification.
Exit interview conducted and report was reviewed with the licensee, Mary Dyer.
A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME:
Seychelle De Luca
TELEPHONE:
(916) 263-5719
LICENSING EVALUATOR NAME:
Kyrsten Williams
TELEPHONE:
(916) 413-0056
LICENSING EVALUATOR SIGNATURE:
DATE:
09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/20/2023
LIC809
(FAS) - (06/04)
Page:
7
of
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