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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621825
Report Date: 05/16/2019
Date Signed: 05/16/2019 10:47:03 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:BROWN, VANESSAFACILITY NUMBER:
343621825
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 8DATE:
05/16/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Colette TIME COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility today for an unannounced annual inspection. Upon arrival LPA observed two infants and six preschoolers placing the facility out of teacher-child ratio. At 10:02am another child was dropped off by parent placing the facility out of capacity. Both are violations and are considered an immediate risk to the children in care. LPA Bello was notified at approximately 9:38am that the licensee was not on the premises and that the children were under care of, Colette Morgan, who does not have criminal record clearance to work with the children. This is considered an immediate risk to the children in care. LPA will return in order to complete the inspection on a later date.

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: 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: BROWN, VANESSA
FACILITY NUMBER: 343621825
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/16/2019
Section Cited
CCR
102370(d)(1)
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Criminal Record Clearance. All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption as required by the Department.
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Licensee understands that adults working with children need to have criminal record clearance. Licensee will have either Colette fingerprinted and associated to her facility or not have her work in the facility by POC date : 5/16/2019
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This is not met be evidence: LPA observed Colette Morgan working in the home without criminal record clearance.
This is a immediate risk to the children in care.
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Type A
05/16/2019
Section Cited
CCR
102416.5(a)
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Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided. This is not met be evidence: LPA observed nine children in the home at time of inspection.
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Licensee acknowledges that she may not exceed the capacity specified on the license. Licensee acknowledges that she must stay within ratio for a large FCCH. Licensee shall ensure that there are no more than specified capacity in care at one time. LPAs will return to clear the deficiency.
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This is a immediate risk to the 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: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
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)
Page: 2 of 2