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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480105782
Report Date: 03/05/2020
Date Signed: 03/05/2020 12:57:19 PM

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:MOTHERS' DAY OUTFACILITY NUMBER:
480105782
ADMINISTRATOR:MARGARET JACOBSFACILITY TYPE:
850
ADDRESS:425 HEMLOCKTELEPHONE:
(707) 448-5159
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY:36CENSUS: 10DATE:
03/05/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Margaret JacobsTIME COMPLETED:
01:10 PM
NARRATIVE
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A inspection was made to the facility by Licensing Program Analyst (LPA) Martinez. The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility’s operating hours are 9AM-1PM, Monday-Friday. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children were observed to be inaccessible to children. Poisons are locked in the custodial closet. The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors by water cooler and inside by their own cups. The children's bathrooms are in safe and sanitary condition. The facility does not provide lunch or snack for children as items are brought from home. The facility does have additional food for snack if a child does not have any or forgot their food. Garbage cans containing solid waste have tight fitting lids. The LPA observed a working carbon monoxide detector in the facility. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is fake grass and shredded bark cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The Director stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met, and 10 children were being supervised by 4 teachers/aides. The facility was operating within the licensed capacity. At least one staff member present during the visit (S1) possessed current CPR and First Aid certifications. The sign-in/sign-out procedure was reviewed and in compliance. Five children’s records were reviewed at 12PM , and contained signed admission agreements. Four staff records were reviewed at 11:40 and contained documentation of education and training as required. Staff were missing mandated reporter training. This facility is not providing Incidental Medical Services (IMS). This report, as well as the AAP Guide to Safe Sleep Practices brochure, were reviewed and discussed with the Director. 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: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Mikah MartinezTELEPHONE: (530) 895-4014
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
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: MOTHERS' DAY OUT
FACILITY NUMBER: 480105782
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/31/2020
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
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 reporter training every two years following the date on which he or she completed the initial mandated reporter training. LPA Martinez observed that Staff for the facility including the director did not complete and update the Mandated reporter training. This is a potential health and safety risk to 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: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Mikah MartinezTELEPHONE: (530) 895-4014
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2020
LIC809 (FAS) - (06/04)
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