393616379-9-13-2019-53-CC-SWIS-BFYP6S-20190913110248

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393616379
Report Date: 09/13/2019
Date Signed: 09/13/2019 11:02:57 AM

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:	GRAHAM, CYNTHIA M		FACILITY NUMBER:	393616379
ADMINISTRATOR:	GRAHAM, CYNTHIA M		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 836-0282
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	14	CENSUS: 3	DATE:	09/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:44 AM
MET WITH:	Cynthia Graham		TIME COMPLETED:	11:15 AM

NARRATIVE

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Licensing Program Analyst (LPA) Stacey Williams met with licensee, Cynthia Graham for an unannounced random annual inspection. LPA observed three (3) children present during the inspection ages 1.5 years, 2 years, and 1 years old. All adult residents and staff have criminal record clearances. LPA toured areas of the home accessible to children in care. Off-limit areas include: master bathroom, laundry room, and garage.

LPA observed fire drills are conducted and documented to meet regulation guidelines. LPA reviewed CPR/First Aid certification which expires August 2020. LPA reviewed a random sample children’s files and licensee and her assistant’s file. Immunization records were reviewed. Required licensing posting requirements were posted. Hazardous items and cleaning supplies were inaccessible to children. Medications are inaccessible to children and located on the top shelf in the kitchen cabinet. Fire extinguisher and smoke detector meet regulation. Carbon monoxide detector was operable.

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.

Report continues the following page, LIC 809C

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019

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: GRAHAM, CYNTHIA M	FACILITY NUMBER: 393616379
	VISIT DATE: 09/13/2019

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LPA discussed the Mandated Reporter Training with licensee. Verification of mandated reporter training was not in licensee and her husband’s file. Mandated training is to be renewed every two years and available at: HTTP://WWW.MANDATEDREPORTERCA.COM

Title 22 deficiencies will be cited on subsequent page, LIC 809D.

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.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019

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: GRAHAM, CYNTHIA M	FACILITY NUMBER: 393616379
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/13/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/11/2019 Section Cited	1 2 3 4 5 6 7	On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child 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.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: LPA did not observe mandated reporter training in licensee or her assistant's file. This is a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14
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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: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019

LIC809 (FAS) - (06/04)

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