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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622079
Report Date: 12/12/2019
Date Signed: 12/12/2019 03:34:33 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:PERDUE, KRISTIFACILITY NUMBER:
393622079
ADMINISTRATOR:PERDUE, KRISTIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 740-0165
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:14CENSUS: 12DATE:
12/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Krisit PerdueTIME COMPLETED:
03:51 PM
NARRATIVE
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Licensing Program Analyst (LPA) Stacey Williams met with licensee, Kristi Perdue for an unannounced random annual inspection. LPA observed (12) twelve children present during today’s inspection. Children were supervised by Licensee and her assistant. Licensee’s hours of operation are Mon-Fri 6:30AM-6:00PM. All adult residents and staff have criminal record clearances.

LPA toured areas of the home accessible to children in care. Off-limit areas include: entire upstairs and the backyard. There is an in-ground pool with a 5-foot mesh fence surrounding the pool. While inspecting the outdoor area, LPA observed the fenced gate self-closes but does not self-latch without assistance when unlocked. The fence remains upright and the licensee has two locks to enforce gate closure. The locks are located at the bottom and top of the fence opening. Licensee indicated the recent weather conditions caused the fencing damage. Licensee stated she will make the outdoor area off limits until the pool fence is repaired. Licensee stated she understands the requirements of off limit areas and will not have any children in any designated off limit areas.

LPA observed fire drills are conducted and documented to meet regulation guidelines. LPA reviewed CPR/First Aid certification which expired in July 2019. LPA reviewed a random sample children’s files and licensee and her assistants’ file. Immunization records were not viewed in licensee or her assistant’s file. Required licensing medical consent, notification, and identification forms were viewed in all files evaluated.

Required licensing postings were viewed on a bulletin board in the entry of the home. 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.

While touring the home, LPA observed a baby walker in the living room area of the home. LPA advised Licensee of the regulation requirements prohibiting baby walkers.

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: 12/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2019
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 4
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: PERDUE, KRISTI
FACILITY NUMBER: 393622079
VISIT DATE: 12/12/2019
NARRATIVE
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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 Mandated Reporter Training with licensee. Verification of training was in licensee and her assistant’s file. Licensee understands that mandated training is to be renewed every two years and available at: HTTP://WWW.MANDATEDREPORTERCA.COM

LPA discussed licensing fees with the licensee. LPA provided the licensee with the pin number should she choose to access payment of the fees online. Licensee informed LPA payment of late fees will be paid by close of business on December 13, 2019.

Title 22 deficiencies observed in the areas evaluated during today’s inspection will be cited on LIC 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 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. A notice of site visit was provided and should remain posted for 30 days for parental review.

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

DATE: 12/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: PERDUE, KRISTI
FACILITY NUMBER: 393622079
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2020
Section Cited

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The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: 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.
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Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view. In addition to meeting all of the aforementioned requirements for fences, gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate. This requirement was not met as evidenced by: While touring the outdoor area, LPA observed an opening on the pool fence which prohibited the gate from self-latching.This is a potential risk to the health and safety of children in care.
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in any backyard areas of the home. Licensee understands plan of correction date is 1/10/19 . LPA will conduct a plan of correction inspection.
Type B
01/10/2020
Section Cited

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Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
This requirement was not met as evidenced by:
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LPA reviewed licensee and her assistant's file which did not have immunization records for MMR, TDAP, TB, or influenza. This is a potential risk to the health and safety of children in care.
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Proof of correction shall be sent to LPA by POC date: 1/10/19
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: 12/12/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: PERDUE, KRISTI
FACILITY NUMBER: 393622079
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2020
Section Cited

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Day care center directors and licensees of family day care homes shall ensure that at least one staff member who has a current course completion card in pediatric first aid and pediatric CPR issued by the American Red Cross, the American Heart Association, or by a training program that has been approved by the Emergency Medical Services Authority pursuant to this section and Section 1797.191 shall be onsite at all times when children are present at the facility, and shall be present with the children when children are offsite from the facility for facility activities. Nothing in this subdivision shall be construed to require, in the event of an emergency, additional staff members, who are onsite when children are present at the facility, to have a current course completion card in pediatric first aid and pediatric CPR.
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This requirement was not met as evidenced by: LPA reviewed licensee and her assistant's file. LPA did not see current cpr/first aid certification in file.Licensee's certification expired July 2019. This is a potential risk of the health and safety of children in care.
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Type B
12/12/2019
Section Cited

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A baby walker is not permitted on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c). This requirement was not met as evidenced by: LPA observed a baby walker in the living room play area of the home. 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: 12/12/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4