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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623177
Report Date: 10/18/2022
Date Signed: 10/18/2022 04:26:11 PM


Document Has Been Signed on 10/18/2022 04:26 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:MINEAR, KATRINAFACILITY NUMBER:
343623177
ADMINISTRATOR:MINEAR, KATRINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 531-2558
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY:14CENSUS: 9DATE:
10/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Katrina MinearTIME COMPLETED:
04:35 PM
NARRATIVE
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On 10/18/22 during an inspection, Licensing Program Analyst (LPA) Fabiola Diaz toured the facility. Licensee explained one child was sleeping upstairs. However, the upstairs is off-limits. Licensee placed the child to nap downstairs during the inspection.

During the visit LPA also observed the spa to have a cover, but the cover had all of it's latches to be unlatched and the lock was unlocked. Licensee latched and locked the cover during the inspection. LPA and licensee checked that the cover did not lift more than 4 inches while locked.

Two type A deficiencies were assessed today, see page LIC812-D. Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit must remain posted for 30 days. Exit interview was conducted and report was reviewed with the licensees.

LPA Diaz informed licensees that this report dated 10/18/22 documents Type A citations which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Diaz informed the licensees to provide a copy of this licensing report dated 10/18/22 that documents any Type A citations 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 (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022
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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Document Has Been Signed on 10/18/2022 04:26 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833


FACILITY NAME: MINEAR, KATRINA
FACILITY NUMBER: 343623177

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/19/2022
Section Cited

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(a)...the licensee shall notify the Department of...: (6)...area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided...This requirement is not met as evidenced by:
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Based on observation and interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Licensee did not ensure that the day care children stay from entering the off-limit area in the facility.
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Type A
10/19/2022
Section Cited

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(g)... Safety precautions shall include...: (5)...shall ensure the inaccessibility of hot tubs, spas...(A) ...covers shall be strong enough to completely support the weight of an adult and shall be placed on the pool and locked while the pool is not in use. This requirement is not met as evidenced by:
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Based on observation and interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Licensee did not ensure to have the spa cover latched and locked.
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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: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022
LIC809 (FAS) - (06/04)
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