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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480112064
Report Date: 08/16/2019
Date Signed: 08/16/2019 11:07:07 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:ARMSTRONG, LORRAINE FAMILY CHILD CARE HOMEFACILITY NUMBER:
480112064
ADMINISTRATOR:ARMSTRONG, LORRAINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 643-3180
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY:14CENSUS: 12DATE:
08/16/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Lorraine ArmstrongTIME COMPLETED:
11:15 AM
NARRATIVE
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An Annual/Random inspection was made to the facility by Licensing Program Analyst (LPA), Melchisedeck Augustin. A review of staff records on 08/16/19 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 three adults living in the home.

During today’s inspection the home and grounds were toured. The licensee and two Assistants (S1 & S2) were supervising twelve 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, one bathroom, and were made inaccessible by door latch and plastic door knob covers. The home was observed to be clean and orderly and was at a comfortable indoor temperature of 76 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 expire 09/28/19 and First Aid certification expire on 09/27/19. 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. LPA did not observe any poisons. 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 04/04/19. 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. At 9:00am, LPA reviewed four staff (S1-S4) and staff records reviewed revealed S3 & S4 are missing proof of immunity against the Measles, Pertussis and Influenza. Staff records reviewed revealed that S3 is missing AB 1207 Mandated Reporter Training certification. Four children's (C1-C4) records were reviewed at 9:19am; current immunizations and Notification of Parent’s Rights forms were on file.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019
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 3
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: ARMSTRONG, LORRAINE FAMILY CHILD CARE HOME
FACILITY NUMBER: 480112064
VISIT DATE: 08/16/2019
NARRATIVE
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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 LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: ARMSTRONG, LORRAINE FAMILY CHILD CARE HOME
FACILITY NUMBER: 480112064
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/28/2019
Section Cited
HSC
1596.8662(b)(1)
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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 reporter training every two years following the date on which he or she
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The Licensee stated S3 will complete the online AB 1207 Mandated Reporter and General Mandated Reporter Training at www.mandatedreporterca.com and the Licensee will submit staff Mandated Reporter Training certification to LPA by 09/28/19 via mail, email or fax
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completed the initial mandated reporter training.
This requirement is not met as evidenced by: Based on staff records reviewed at 9:00am. Staff records reviewed revealed that S3 is missing AB 1207 Mandated Reporter Training certification. This poses a potential health and safety risk to the children in care.
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Email: melchisedeck.augustin@dss.ca.gov
Fax: 707-588-5099
Type B
09/13/2019
Section Cited
HSC
1597.622(a)(1)
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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.
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The Licensee stated S3 & S4 will request proof of immunity against the Measles, Pertussis and Influenza from their medical provider. The Licensee stated she will submit staff required immunization records to LPA by 09/13/19 via mail, email or fax.
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This requirement is not met as evidenced by: Based on staff records reviewed at 9:00am. staff records review revealed S3 & 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.
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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 LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3