390321204-12-11-2023-53-CC-TDIP-CYF2RX-20231211163818

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 390321204
Report Date: 12/11/2023
Date Signed: 12/11/2023 04:38:36 PM

Document Has Been Signed on 12/11/2023 04:38 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	MORTIMER, MICHELE		FACILITY NUMBER:	390321204
ADMINISTRATOR:	MICHELE MORTIMER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 482-5523
CITY:	RIPON	STATE: CA	ZIP CODE:	95366
CAPACITY:	14	CENSUS: 7	DATE:	12/11/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Michele Mortimer		TIME COMPLETED:	04:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 12/11/2023 at 1:30 PM, Licensing Program Analyst (LPA) Tiffanie Diep met with Licensee Michele Mortimer for the purpose of an unannounced annual inspection. Entrance Checklist (LIC 126) was provided to Licensee and Licensee guided LPA on a tour of the home. Licensee provided proof of control of property. LPA observed seven children present in the home with Licensee and their spouse/assistant. Licensee's operating hours are Monday through Friday from 7:00 AM to 6:00 PM. All individuals subject to a criminal record review have obtained a criminal record clearance. 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 five 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. LPA reviewed five children's files, and LPA observed emergency information and required immunization records were on file. LPA observed a current roster and documentation that a fire drill is conducted at least once every six months. LPA verified Licensee's immunization records were available in the facility file. Current Mandated Reporter Training certificate was verified and expires on 07/02/2025. LPA discussed the mandated reporter training requirement and Licensee was reminded to ensure assistants renew the course every two years. EMSA pediatric CPR and first aid certification expired on 02/08/2022. LPA discussed the requirement to renew CPR and first aid certification every two years prior to expiration. Continues on 809-C

SUPERVISOR'S NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Tiffanie Diep	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MORTIMER, MICHELE	FACILITY NUMBER: 390321204
	VISIT DATE: 12/11/2023

NARRATIVE

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Continued from 809 (Page 2)

A health and safety inspection of the home’s interior and exterior was conducted in all areas accessible to children. LPA observed stairs to the second floor barricaded by a baby gate. LPA observed the required postings and a working phone. LPA observed a 3A40BC fire extinguisher meets regulations and verified both smoke and carbon monoxide detectors were functional. LPA toured the kitchen area and verified knives were inaccessible to children in care. LPA observed a restroom and verified that toxic and hazardous items were inaccessible to children in care. LPA observed cleaners stored in kitchen cabinets out of reach and inaccessible to children in care. LPA observed the playroom/garage with age-appropriate toys for children. Licensee stated there are no weapons in the home. LPA observed a fireplace that was barricaded by an iron screen. Per Licensee’s request, the off-limits areas in the home will now include the downstairs bedroom, entire second floor, gated pool area in backyard, and both side yards. The outdoor play area was inspected and is surrounded by a wooden fence. LPA walked the perimeter of the outdoor play area during inspection and verified that the entire area is fenced in. The backyard has an in-ground pool area that is fenced according to Title 22 Regulations, and LPA observed the gate to self-close and self-latch. There is also a hot tub located in the backyard. LPA observed latches on all four sides of the hot tub cover.

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. LPA discussed the requirement to check and log infant napping every 15 minutes for infants under 24 months. LPA provided a copy of the Individual Sleeping Plan (LIC 9227) for infants under 12 months.

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) or (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/.

SUPERVISOR'S NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Tiffanie Diep	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MORTIMER, MICHELE	FACILITY NUMBER: 390321204
	VISIT DATE: 12/11/2023

NARRATIVE

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Continued from 809-C (Page 3)

To improve the quality and value of the new inspection process, a survey may be sent to the e-mail address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE Tool, please send e-mail inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. Licensee was informed of the MyChildCarePlan.org site, 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.

Based on LPA’s observations, interviews conducted, and records reviewed, a deficiency is being cited on the attached LIC 809-D. LPA Tiffanie Diep informed the licensee, Michele Mortimer, that this report dated 12/11/2023 documents one Type B citation as there was a potential risk to the health, safety, or personal rights of children in care.

An exit interview was conducted and report was reviewed with the licensee, Michele Mortimer. During the exit interview, Licensee confirmed that there are no registered sex offenders (RSO) living in the facility and LPA completed the RSO profile in the Field Automation System. A notice of site visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Tiffanie Diep	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/11/2023 04:38 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MORTIMER, MICHELE	FACILITY NUMBER: 390321204
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations, interviews conducted, and records reviewed, the licensee did not comply with the section cited above as licensee did not ensure they renewed their EMSA pediatric CPR and first aid certification by the expiration date which poses a potential health, safety, or personal rights risk to children in care.
	POC Due Date: 01/11/2024
	Plan of Correction
1 2 3 4	LPA reminded Licensee to renew CPR and first aid certification every two years prior to expiration. Licensee agreed to provide proof of enrollment and/or completed certificate to LPA by 01/11/2024.

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: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Tiffanie Diep	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

LIC809 (FAS) - (06/04)

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