393606299-3-30-2023-53-CC-ESIA-CQEQRN-20230330122414

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393606299
Report Date: 03/30/2023
Date Signed: 03/30/2023 12:24:24 PM

Document Has Been Signed on 03/30/2023 12:24 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:	FIELDS,DENISE		FACILITY NUMBER:	393606299
ADMINISTRATOR:	FIELDS,DENISE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 472-9319
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY:	14	CENSUS: 8	DATE:	03/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Denise Fields		TIME COMPLETED:	12:40 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 March 30, 2023, Licensing Program Analyst (LPA) Elvira Sierra met with the licensee, Denise Fields and her assistant/husband Joe Fields for the purpose of an annual inspection. Per licensee her new hours of operation are seven days a week from 06:00am to 08:00pm. A review of the Facility Personnel Summary shows that all adults living and working in the home have criminal record clearances on file with Licensing Office. Licensee stated that no new residents moved into the home since licensure. Upon arrival present in the facility were Licensee and assistant caring for 8 children (3 children are licensee's grandchildren). Capacity specified on the license was met on today’s inspection. Also present was licensee's adult son. Licensee's husband/assistant arrived later during the inspection. A health and safety inspection was conducted in all areas accessible to children. Off limit areas are: Bedroom # 2, Master Bedroom (including bathroom inside master bedroom) ,Garage, Right and left side of the backyard. Licensee was reminded that day care children may never enter these off-limit areas. Licensee was also advised to contact Licensing office of any changes to the home previously identified as off limit to an area where care and supervision will be provided and if new construction is done to the home. Upon entry, LPA observed the posting of the facility license, Emergency Disaster Plan, Earthquake Preparedness Checklist and Notification of Parent Rights. Home is clean and appropriately ventilated. Age-appropriate toys and reading material were observed. There were no hazardous materials or chemicals accessible to children. Medications are inaccessible to children and kept in the kitchen on a top cabinet. The fireplace in the home is appropriately barricaded to prevent access by children. Licensee stated there are no weapons in the home. No bodies of water were observed on the premises. Home has a pet that is not accessible to children. Facility maintains a working phone, 2A10BC fire extinguisher, and a functioning smoke/carbon monoxide detector. Backyard is fenced for supervision. Facility has an outdoor wooden play structure that has wooden chips under and around the structure to absorb falls. Licensee was advised to make sure that the play structure is always secured to the ground and in good repair. Report continues on subsequent page 809C--

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: FIELDS,DENISE	FACILITY NUMBER: 393606299
	VISIT DATE: 03/30/2023

NARRATIVE

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Current in person EMSA CPR and First Aid certification was verified and expires on 04/25/23. LPA discussed the AB 1207 Mandated Reporter Training and advised that the training must be updated every two years. LPA also advised that a current roster must be available for review for Licensing during inspection visit. LPA observed fire drills are conducted at least once every six months and are properly log. Last fire drill was conducted on 01/05/23.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

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 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
See next page 809D for deficiencies cited on today's inspection. This report and Appeal of Rights were provided and reviewed with Licensee, Denise Fields. Exit interview conducted and Notice of site Visit was posted.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/30/2023 12:24 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: FIELDS,DENISE	FACILITY NUMBER: 393606299
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/30/2023

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 out of 3 person which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/30/2023
	Plan of Correction
1 2 3 4	Licensee stated that she will submit the training certificates for Licensee, her husband and her assistant by the due date to LPA.

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in one out of one assistant which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/30/2023
	Plan of Correction
1 2 3 4	Licensee stated that she will submit proof of IMM for her assistant by the 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: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC809 (FAS) - (06/04)

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