393619966-3-26-2024-53-CC-LSCT-D3QQLE-20240326121550

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393619966
Report Date: 03/26/2024
Date Signed: 03/26/2024 12:15:59 PM

Document Has Been Signed on 03/26/2024 12:15 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	HOME CHURCH, THE		FACILITY NUMBER:	393619966
ADMINISTRATOR:	MAY COOPER		FACILITY TYPE:	850
ADDRESS:	11451 NORTH WEST LANE		TELEPHONE:	(209) 339-7333
CITY:	LODI	STATE: CA	ZIP CODE:	95242
CAPACITY:	24	CENSUS: 8	DATE:	03/26/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Director, May Cooper		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	On March 26, 2024, Licensing Program Analyst (LPA) Lauren Scott met with Director, May Cooper for the purpose of an unannounced annual inspection. Facility days and hours of operation are Monday-Friday from 8:00 AM to 11:45 AM. There were 10 children present during today's inspection. LPA reviewed the sign in/out book and observed that the children are properly signed in. LPA verified the annual fees are current. Licensee was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. LPA toured the facility inside and out. LPA observed that hazardous items were inaccessible to children in care. LPA reviewed staffing ratios, first aid supplies, fire drills and drinking water. LPA observed all required forms to be posted. LPA observed functioning smoke alarms and carbon monoxide detectors. LPA observed the toys, furniture and equipment to be in good condition. Outdoor play area was toured, the play structure appeared to be in good repair, and there is sufficient cushioning (cushioned tiles) under the play structure. Facility does not provide food to children in care. LPA reviewed children’s and staff files. LPA observed health screening reports with TB test and required MMR and TDAP vaccines for all adults and children. LPA observed at least one staff with current Pediatric CPR and First Aid. LPA discussed the requirement of AB1207 Mandated Reporter training certificates for all staff. The director was reminded to renew the course every 2 years through www.mandatedreporterca.com website. Report continues on 809-C

SUPERVISOR'S NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Lauren Scott	TELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HOME CHURCH, THE	FACILITY NUMBER: 393619966
	VISIT DATE: 03/26/2024

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/

LPA referred licensee to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Exit interview conducted and report was reviewed with the director, May Cooper. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements may result in an immediate civil penalty of $100.

LPA Scott informed director, May Cooper that this report dated 03/26/2024 documents one Type A citation. Type A citations which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care. Also, LPA Scott informed the director to provide a copy of this licensing report dated 03/26/2024 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISOR'S NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Lauren Scott	TELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/26/2024 12:15 PM - 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HOME CHURCH, THE	FACILITY NUMBER: 393619966
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101170(e)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above where one staff did not have a cleared background check, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/27/2024
	Plan of Correction
1 2 3 4	Facility will remove the individual from the facility until a background check is clear. Facility will make sure background check is cleared prior to an employee starting at the facility

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Lauren Scott	TELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

LIC809 (FAS) - (06/04)

Page: 2 of 5

Document Has Been Signed on 03/26/2024 12:15 PM - 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HOME CHURCH, THE	FACILITY NUMBER: 393619966
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day 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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above where staff mandated reporter training certificates were expired, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/26/2024
	Plan of Correction
1 2 3 4	Facility will complete mandated reporter trainining and submit proof of certificate to LPA by POC date

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Lauren Scott	TELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

LIC809 (FAS) - (06/04)

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