455406502-12-9-2019-13-CC-CWIT-BJPQJV-20191209111318

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 455406502
Report Date: 12/09/2019
Date Signed: 12/09/2019 11:13:33 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	MAZZANTI, JENNA FAMILY CHILD CARE HOME		FACILITY NUMBER:	455406502
ADMINISTRATOR:	MAZZANTI, JENNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 949-4460
CITY:	COTTONWOOD	STATE: CA	ZIP CODE:	96022
CAPACITY:	14	CENSUS: 5	DATE:	12/09/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Jenna Mazzanti		TIME COMPLETED:	10:50 AM

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	A annual inspection was made to the facility by Licensing Program Analyst (LPA), Wisehart. A review of staff records on 12/9/19 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently two adult is living in the home. The Preventive Health Course was taken by licensee under prior license of Ferguson. During today’s inspection the home and grounds were toured. The Fire Drill was conducted on Aug 20, 2019 The licensee was supervising 5 children, one who is under 2 years of age, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are 7 am to 5:30 pm , Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are Master bed/bath and two bedrooms, and were made inaccessible by locks. The home is clean, orderly and comfortable. There are safe toys and equipment available for children. There is a working telephone in the home. The licensee had a pediatric CPR and First Aid certification, which expired on 11/30/19 and the licensee has a classed schedule for 12/12/19. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. Poisons are locked in shed back yard. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection. The children use the back yard as the outdoor play area and it is fully fenced.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2019

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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: MAZZANTI, JENNA FAMILY CHILD CARE HOME	FACILITY NUMBER: 455406502
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/09/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/23/2019 Section Cited	1 2 3 4 5 6 7	Personnel Requirements 1596.866 (1)(b) A current pediatric first aid card issued either by the American Red Cross or by a training program that has been approved by the Emergency Medical Services Authority pursuant to Section 1797.191
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on record review the licensee's CPR/First Aid card expired on 11/30/19. This poses a potential risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2019

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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: MAZZANTI, JENNA FAMILY CHILD CARE HOME	FACILITY NUMBER: 455406502
	VISIT DATE: 12/09/2019

NARRATIVE

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There is no pool or body of water on the premises. Five children's records were reviewed at 9:52 am; the required emergency information was observed to be on file. The licensee is not providing Incidental Medical Services (IMS) to children in care. The Incidental Medical Services (IMS) policy was discussed with the licensee. 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 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, www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices brochure, were reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2019

LIC809 (FAS) - (06/04)

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