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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393609442
Report Date: 04/27/2023
Date Signed: 04/28/2023 09:02:56 AM


Document Has Been Signed on 04/28/2023 09:02 AM - 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:BROWN, GERMAINEFACILITY NUMBER:
393609442
ADMINISTRATOR:BROWN, GERMAINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 271-3016
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:14CENSUS: 2DATE:
04/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Germaine BrownTIME COMPLETED:
12:00 PM
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On 04/27/23, Licensing Program Analyst (LPA) Elvira Sierra met with the licensee, Germaine Brown for the purpose of an unannounced annual inspection. Facility hours of operation are M-F from 06:00am to 08:00pm. Licensee stated that no new residents moved into the home since licensure. Capacity specified on the license was met on today’s inspection. Present in the facility was Licensee caring for two daycare children.

A health and safety inspection was conducted in all areas accessible to children. Off limit areas include; All bedrooms and the garage. Licensee was reminded that day care children may never enter these off-limit areas. Age-appropriate toys and reading material were observed. There were no hazardous materials or chemicals observed accessible to children. Medications and knives are inaccessible to children and kept in top kitchen cabinets. Home has a chimney that is properly barricaded. Facility maintains a working phone, a 2A10BC fire extinguisher, a functioning smoke and a carbon monoxide detector. Licensee stated there are no weapons in the home. LPA observed there is a spa in the backyard that is covered with a spa cover. LPA observed that one of the spa cover straps was broken. Backyard is fenced for supervision. LPA observed a couple of the wood fence slats loose and unscrew. Licensee stated that she provides meals to the daycare children.

Licensee transports children. Licensee acknowledges that only drivers licensed for the type of vehicle to be operated shall be permitted to transport children in care, the manufacturer's rated seating capacity of the vehicle shall not be exceeded, motor vehicles used to transport children in care shall be maintained in safe operating condition, and all vehicle occupants must be secured in an appropriate restraint system. Current in person EMSA CPR and First Aid certification was verified and expires 04/14/25. Fire drill was conducted last in 03/2023. Mandated Reporter certificate was observed and expires on 04/27/25. LPA reviewed 2 children files. Files are complete with the required documentation by regulation.

Report continues on subsequent page 809C---
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2023
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: BROWN, GERMAINE
FACILITY NUMBER: 393609442
VISIT DATE: 04/27/2023
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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 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 [facility representative] 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.

Exit interview conducted. This report and Appeal of Rights were provided to Licensee, Germaine Brown.


A notice of site visit was given and must remain posted for 30 days
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/28/2023 09:02 AM - 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: BROWN, GERMAINE
FACILITY NUMBER: 393609442

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations the licensee did not comply with the section cited above by: A section of the wooden fence in the backyard needs repair. LPA observed 2 fenced slats unscrewed from the fenced. This is a requirement which poses a potential health, safety or personal rights risk
POC Due Date: 05/27/2023
Plan of Correction
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Licensee stated that she will repair the section of the fence before the POC due date, Licensee also stated that she will not be using the backyard until everything is repair.
Type B
Section Cited
CCR
102417(g)(5)

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (5) 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 by:
Deficient Practice Statement
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Based on observations the licensee did not comply with the section cited above by having one of the spa cover locks broken. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/27/2023
Plan of Correction
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Licensee stated that she will insalled a new lock and send proof of correction by due date. Spa does not have water.
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 EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2023
LIC809 (FAS) - (06/04)
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