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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500294
Report Date: 08/12/2021
Date Signed: 08/12/2021 02:02:17 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:PETTIS HOUSTON, PAMELAFACILITY NUMBER:
394500294
ADMINISTRATOR:PETTIS HOUSTON, PAMELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 910-0110
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY:14CENSUS: 10DATE:
08/12/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:37 AM
MET WITH:Pamela Pettis HoustonTIME COMPLETED:
01:38 PM
NARRATIVE
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On 08/12/21 Licensing Program Analyst (LPA) Aruna Sridharan met with licensee Pamela Pettis Houston for unannounced annual inspection. LPA followed infection control protocols. The hours of operation are 24 hours Monday through Saturday.

The family child care home facility is two story single family home with four bedrooms in the upstairs and one bedroom, bathroom, living room, kitchen and garage in the first floor. Today's census was one infant and nine preschoolers. The daycare is conducted in the garage.
Off limit areas: Entire upstairs, bedroom in first floor and shed in the backyard. Licensee acknowledges that children may never enter these off-limit areas. The backyard is fenced. Licensee was notified that prior to use of any off limits area, the department must be notified.
A tour of the home, inside and outside, as shown on the facility sketch was conducted. The house has a working telephone, fully charged fire extinguisher, smoke detector and carbon monoxide detector that meet regulations. The first aid kit is located in the daycare next to entrance. As per the licensee, there are no firearms or weapons in the home. LPA observed cleaning compound's under the kitchen sink with cabinet locked and medications stored in upper cabinet in the kitchen.
Safe toys and play equipment are observed. LPA observed all the required postings, reviewed all staff and childrens records. One staff member present today during inspection did not have clearance as the status was pending. This is an immediate risk to the children in care and hence a Type A citation. Licensee was provided 9224 to have current parents sign with first box checked and prospective parents sign with last box checked.
LPA discussed the Safe Sleep regulations. LPA observed the record of licensee’s immunization on file. LPA reviewed children's roster and fire drill log last conducted on 06/11/21. LPA requested a copy of children's roster from the licensee. Licensee had CPR/First aid card that expires on 07/23 and Mandated Reporter AB 1207 that expires on 06/23.
The facility is following all the Covid precautions while providing care for children.
Title 22 Deficiencies observed in the areas were cited on 809D page. LPA reviewed report with the Licensee and provided copies. An exit interview was conducted. Appeal rights provided. Notice of Site Visit was provided, and licensee understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
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: PETTIS HOUSTON, PAMELA
FACILITY NUMBER: 394500294
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/13/2021
Section Cited

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All individuals subject to a criminal record review shall obtain a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. This was not evidenced by;
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The licensee had Staff 1 who was not fingerprint cleared.
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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: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:
DATE: 08/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2021
LIC809 (FAS) - (06/04)
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