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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393616972
Report Date: 01/27/2020
Date Signed: 01/27/2020 01:09:00 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:MALLARD, CHARLOTTEFACILITY NUMBER:
393616972
ADMINISTRATOR:MALLARD, CHARLOTTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 879-9570
CITY:MOUNTAIN HOUSESTATE: CAZIP CODE:
95391
CAPACITY:14CENSUS: 7DATE:
01/27/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:48 AM
MET WITH:Charlotte Mallard TIME COMPLETED:
01:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Stacey Williams met with licensee, Charlotte Mallard for an unannounced annual inspection. There were (7) seven children present during today’s inspection. Licensee’s husband and two Assistants were also present. Criminal record clearances were verified. The facility hours of operation are 6AM-6:30PM.

LPA toured areas of the home accessible to children in care. Off-limit areas include the entire upstairs and the garage. The backyard is fenced, and licensee acknowledges that children may never be left unsupervised in an unfenced area of the front yard. There are no bodies of water at the residence.

Required licensing postings were viewed on the wall in the entry of the home. Hazardous items and cleaning supplies and medications are inaccessible to children. Fire extinguisher, smoke detector, and Carbon monoxide detector meet regulation standards.

LPA observed fire drills are conducted and documented to meet regulation guidelines. LPA reviewed CPR/First Aid certification which expires in August 2020.

LPA reviewed children and licensee and her Assistant’s files. Immunization records were not viewed in all staff files. All required licensing forms were verified in each child and licensee file.


Report continues the following page, LIC 809C
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: MALLARD, CHARLOTTE
FACILITY NUMBER: 393616972
VISIT DATE: 01/27/2020
NARRATIVE
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LPA discussed the Mandated Reporter Training with licensee. Mandated training is to be renewed every two years and available at: HTTP://WWW.MANDATEDREPORTERCA.COM . Mandated reporter certification was not verified in licensee or her Assistant’s files.

Incidental Medical Services (IMS) policy was discussed. 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.

Title 22 deficiencies observed during today’s inspection will be cited on subsequent page, 809D.

This facility evaluation report was reviewed and discussed with the licensee. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for childcare updates, current forms, legislation and regulation information. LPA registered Licensee to receive quarterly updates during today’s inspection.

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. A notice of site visit was provided and should remain posted for 30 days for parental review. Appeal rights were discussed and provided to licensee.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: MALLARD, CHARLOTTE
FACILITY NUMBER: 393616972
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/03/2020
Section Cited

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The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.
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This requirement was not met as evidenced by: LPA conducted a file review and did not observe immunization reocords for licensee's assistant. Files were missing MMR immunization for Licensee and her Assistants. Assitant (S1) was missing MMR, TDAP, TB. This is a potential risk to the health and safety of children in care.
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Type B
02/27/2020
Section Cited

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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.
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This requirement was not met as evidenced by: LPA conducted a file review and did not observe mandated reporter training certificates in Licensee and her Assistant's files. This is a potential 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: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3