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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623177
Report Date: 10/22/2021
Date Signed: 10/22/2021 04:29:48 PM

Document Has Been Signed on 10/22/2021 04:29 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
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: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 9DATE:
10/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Katrina MinearTIME COMPLETED:
04:35 PM
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On 10/22/21 Licensing Program Analyst (LPA) Fabiola Diaz met with licensee Katrina Minear for unannounced annual inspection. Present in the facility was licensee’s husband, assistant, and own children.

The two story home has an unfenced front yard, 4 bedrooms, napping room, play room, garage, kitchen, living room, dining room area, fenced backyard, loft, laundry room, and 3 bathrooms. The off-limits areas in the home are entire upstairs, garage, and right side of backyard. Off-limits areas will remain inaccessible to children by closed doors and/or supervision. Licensee acknowledges that children may never enter these off-limit areas. Licensee was notified that prior to use of any off limits area, the department must be notified.
A health and safety inspection was conducted in the areas accessible to children. The house has a working telephone, fully charged fire extinguisher, smoke detector and carbon monoxide detector that meet regulations. The first aid kit is located in the kitchen. Licensee stated she has not weapons in the home. The home has a spa in the backyard with a locked cover meeting Title 22. Cleaning compounds and hazardous items were inaccessible to children. Safe toys and play equipment were observed. LPA discussed and observed all the required postings. The home has a fireplace that is barricaded meeting Title 22. LPA advised the applicant that if there are any poisons at the home, all poisons must be locked with a key lock or combination lock.

LPA Diaz did not observe the record of licensee’s and assistant's immunization in facility file. Children's roster was observed, and fire drill log was discussed. Licensee explained a Fire Drill was completed in October 2021, but was not documented. Licensee's CPR/First aid card expired, and licensee demonstrated proof of her enrollment for 10/29/21. Mandated Reporter Training for licensee and assistant was not observed. Licensee understands training must be complete every two years.
Report continues on 809C................
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Fabiola Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2021
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: MINEAR, KATRINA
FACILITY NUMBER: 343623177
VISIT DATE: 10/22/2021
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

LPA discussed the safe sleep regulations with 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Licensee was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Title 22 Deficiencies were observed in the areas of today's facility evaluation, which are written in the LIC809-D. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Katrina Minear.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Fabiola Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/22/2021 04:29 PM - It Cannot Be Edited


Created By: Fabiola Diaz On 10/22/2021 at 04:13 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: MINEAR, KATRINA
FACILITY NUMBER: 343623177

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. LPA did not observe current Mandated Reporter for licensee and adult assistant, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2021
Plan of Correction
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Licensee will provide LPA with proof of current Mandated Reporter for licensee and adult assistant.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Licensee and adult assistant did not provide with immunization records, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2021
Plan of Correction
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Licensee will provide proof of licensee's and adult assistant's immunization records by POC due date.
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 Saravia
LICENSING EVALUATOR NAME:Fabiola Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 10/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2021


LIC809 (FAS) - (06/04)
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