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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393614466
Report Date: 02/03/2020
Date Signed: 02/03/2020 03:55:46 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:ENIS, JOANFACILITY NUMBER:
393614466
ADMINISTRATOR:ENIS, JOANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 366-2200
CITY:LODISTATE: CAZIP CODE:
95242
CAPACITY:14CENSUS: 12DATE:
02/03/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Joan EnisTIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Justin Denton conducted an unannounced case management inspection to follow-up on an report received in the Sacramento South Regional Office on 1/31/20. LPA met with Licensee Enis..

The Department received a report that a staff member placed the child in a high chair but did not securely strap the child in. When Licensee Enis removed the tray from the chair to take the child out, the child fell from the chair. The child sustained a head injury which required medical attention.

Deficiencies cited on the attached 809-D.

A copy of this report was left with the facility.

Exit interview conducted and Notice of Site Visit posted.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020
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: ENIS, JOAN
FACILITY NUMBER: 393614466
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/04/2020
Section Cited

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Personal Rights: Each child receiving services from a family child care home shall (...) receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement was not met as evidenced by:

Staff failed to secure infant in high chair,
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resulting in the infant falling from the chair and sustaining a head injury. This is an immediate risk to the health and safety of children in care.
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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: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2020
LIC809 (FAS) - (06/04)
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