393607983-9-5-2019-53-CC-SWIS-BFQQKH-20190905121423

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393607983
Report Date: 09/05/2019
Date Signed: 09/05/2019 12:14:31 PM

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:	SMITH, GLORIA		FACILITY NUMBER:	393607983
ADMINISTRATOR:	SMITH, GLORIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 956-9334
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	14	CENSUS: 4	DATE:	09/05/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Gloria Smith		TIME COMPLETED:	12:30 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	Licensing Program Analysts (LPA) Stacey Williams and Tanya Washington met with licensee, Gloria Smith for an unannounced random annual inspection. LPAs observed four (4) preschool aged children present during the inspection. All adult residents and staff have criminal record clearances. Off-limit areas include: all bedrooms, garage, and backyard. LPAs observed fire drills are conducted and documented to meet regulation guidelines. LPAs reviewed CPR/First Aid certification which expires August 2020. LPAs reviewed random sample of children’s’ files. Licensee’s file was also reviewed. Immunization records were reviewed. LPAs toured all areas of the home accessible to children. LPAs observed an above ground pool located in the backyard. Licensee indicated that the pool was installed at the end of June, 2019. Licensee did indicate that day-care children have no access to the pool and she has installed a safety latch on the French door leading out to the pool plus she has a safety gate installed. Licensee also has an alarm sound when any of her doors or windows open. LPA Washington asked Licensee if she has informed her LPA prior to installation of the pool and she stated she did not. Title 22 Regulation requires all bodies of water to be properly fenced. (Regulation provided and discussed). Licensee stated that the pool will be removed from the property next week. Licensing posting requirements were observed in the entry of the home on a wall above the front closet. Hazardous items and cleaning supplies were inaccessible to children. Medications are inaccessible to children in the cabinet located in the hallway. Fire extinguisher and smoke detector meet regulation. Carbon monoxide detector was operable. Continued on LIC809C

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019

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: SMITH, GLORIA	FACILITY NUMBER: 393607983
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/05/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/06/2019 Section Cited	1 2 3 4 5 6 7	All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence. This requirement is not met as evidenced; LPAs observed an unfenced above ground pool located in the backyard of the home.
	8 9 10 11 12 13 14	Although Licensee stated the backyard is off limits to day-care children, all bodies of water are required to be fenced according to Title 22 Regulations. This is an immidiate risk to the health and safety of children in care. An immidiate $500.00 civil penalty is assessed.	8 9 10 11 12 13 14	Licensee will submit photos after the pool is removed. Failure to correct the citation may result in additional fines.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019

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: SMITH, GLORIA	FACILITY NUMBER: 393607983
	VISIT DATE: 09/05/2019

NARRATIVE

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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.

LPAs discussed the Mandated Reporter Training with licensee. Verification of mandated reporter training was in licensee’s file. Mandated training is to be renewed every two years and available at: HTTP://WWW.MANDATEDREPORTERCA.COM

This facility evaluation report was reviewed and discussed with the licensee. A notice of site visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. The implementation of AB 2370, lead exposure in Family Child Care Homes and proposed safe sleep regulations was discussed. A copy of this report will remain on file for a period of 3 years for public review upon request. Appeal rights were discussed and provided to licensee.

A Type A deficiency is being cited for unfenced body of water – 102417(g)(5) – Operation of Family Child Care Home. Upon receipt, licensee shall post and provide copies of this licensing report to parents/ guardians of children who are currently enrolled as well as parents/ guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must acknowledge receipt of this report and citation by signing a LIC9224, “ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS”. A copy of this form should be placed in each child file upon receipt from parent. An exit interview was conducted. A notice of site visit and appeal rights were provided.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019

LIC809 (FAS) - (06/04)

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