480109049-12-6-2019-01-CC-MAUN-BJLPY7-20191206104329

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 480109049
Report Date: 12/06/2019
Date Signed: 12/06/2019 10:43:45 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME:	SPENCER FAMILY DAY CARE		FACILITY NUMBER:	480109049
ADMINISTRATOR:	SPENCER, JOYCE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 645-0514
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94589
CAPACITY:	14	CENSUS: 6	DATE:	12/06/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:08 AM
MET WITH:	Joyce Spencer		TIME COMPLETED:	11:00 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	An Annual/Random inspection was made to the facility by Licensing Program Analyst (LPA), Melchisedeck Augustin. A review of staff records on 12/06/19 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 four adults adults living in the home. During today’s inspection the home and grounds were toured. The licensee and three assistants (S1, S2 and S3) were supervising six children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are 6:00am to 6:00pm, Mon–Fri. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are four bedrooms, two bathroom and living room, and were made inaccessible by a child safety gate. The home has a converted garage where care is provided. The home was observed to be clean and orderly, and was at a comfortable indoor temperature of 72 degrees Fahrenheit. There were safe toys and equipment available for children. The licensee stated there is a working telephone in the home. The licensee’s pediatric CPR and First Aid certifications were reviewed, and expire on 10/21/20. At 8:39am, LPA requested AB 1207 Mandated Reporter Training certification for S2 and S3, however; the Licensee did not furnish proof of staff AB 1207 Mandated Reporter Training certifications for S2 and S3. Staff records reviewed revealed that S1, S2 and S3 are missing proof of a negative TB clearance. LPA issued an Advisory Note for this Technical Violation. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be stored out of the reach of children. Poisons were locked in the garage storage closet. The fireplace has been made inaccessible with a screen. The LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The roster of children in care was reviewed and was current. The licensee has conducted an emergency drill within the past six months, last drill was documented on 09/06/19.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019

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,
, CA

FACILITY NAME: SPENCER FAMILY DAY CARE	FACILITY NUMBER: 480109049
	VISIT DATE: 12/06/2019

NARRATIVE

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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 backyard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed. One child's record were reviewed at 8:45am; current immunization, and Notification of Parent’s Rights forms were on file. Three staff (S1, S2 and S3) records were reviewed at 9:11am and staff records reviewed revealed that S2 and S3 are missing proof of immunity against the Measles, Pertussis and Influenza. 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 and The Effects of Lead Exposure brochures, 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: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019

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,
, CA

FACILITY NAME: SPENCER FAMILY DAY CARE	FACILITY NUMBER: 480109049
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/06/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/21/2020 Section Cited	1 2 3 4 5 6 7	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 reporter training every two years following the date on which he or she completed the initial mandated reporter training.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on the Licensee's failure to furnish proof of AB 1207 Mandated Reporter Training certificates for S2 and S3. This poses a potential health and safety risk to the children in care.	8 9 10 11 12 13 14	Email: melchisedeck.augustin@dss.ca.gov Fax: 707-588-5099
Type B 01/03/2020 Section Cited	1 2 3 4 5 6 7	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.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on staff records reviewed at 9:11am. staff records reviewed revealed that S2 and S3 are missing proof of immunity against the Measles, Pertussis and Influenza. This poses a potential health and safety risk to the children in care.	8 9 10 11 12 13 14	Email: melchisedeck.augustin@dss.ca.gov Fax: 707-588-5099

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: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019

LIC809 (FAS) - (06/04)

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