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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621637
Report Date: 05/16/2019
Date Signed: 05/16/2019 02:58:53 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:PIERCE, TIFFANYFACILITY NUMBER:
343621637
ADMINISTRATOR:PIERCE, TIFFANYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 743-0397
CITY:SACRAMENTOSTATE: CAZIP CODE:
95833
CAPACITY:14CENSUS: 3DATE:
05/16/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Tiffany Pierce, LicenseeTIME COMPLETED:
03:10 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Joleen Kenney and Rosie Pitts conducted a case management inspection and met with the Licensee, Tiffany Pierce. During a visit for a unrelated inspection, LPAs observed a child in a baby bouncer that is baby equipment that is not permitted in a licensed family child care home.

Type A deficiency is cited on the following page of this facility evaluation report..

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/guardians and kept as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 is available on the website. If the LIC 9224 is not used, the licensee shall prepare a statement indicating the documents have been provided. Licensee shall require the parent/guardian to sign and date the statement and shall keep the signed statement as receipt. Verification of receipt shall be kept in each child's file at the facility.

Exit interview conducted. Appeal Rights were provided. Notice of Site Visit was provided and posted.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen KenneyTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019
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 2
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: PIERCE, TIFFANY
FACILITY NUMBER: 343621637
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/17/2019
Section Cited
CCR
102417(d)
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Operation of a Family Child Care Home. The home shall provide safe toys, play equipment and materials. This is not met as evidenced by: LPAs observed a child in a baby bouncer in the living room which is not permitted in a family child care home. This is an immediate health and safety risk to children in care.
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Licensee stated that she did not know that she was not allowed to use the baby bouncer. Licensee removed the bouncer at the time of the visit and stated that she will be disposing of it from her home. LPAs provided a hand out regarding safe equipment and also
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discussed safe sleeping practices for infants.

The deficiency was cleared during today's visit.
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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: 05/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019
LIC809 (FAS) - (06/04)
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