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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483007066
Report Date: 02/19/2020
Date Signed: 02/19/2020 04:23:13 PM

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:NEWTON FAMILY CHILD CARE HOMEFACILITY NUMBER:
483007066
ADMINISTRATOR:NEWTON, DEANDRA AND JAMESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 647-3976
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:14CENSUS: 10DATE:
02/19/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:39 PM
MET WITH:Deangela Butler and Deandra NewtonTIME COMPLETED:
04:35 PM
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A Required inspection was made to the facility by Licensing Program Analyst (LPA), Melchisedeck Augustin. A review of staff records on 02/19/20 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 is currently one adult living in the home.

During today’s inspection the home and grounds were toured. The licensee and three (S1, S2 and S3) assistants were supervising ten 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 the entire upper level of the home and one bedroom on the lower level, and were made inaccessible by child safety gate and door locking mechanisms. The home was observed to be clean and orderly, and was at a comfortable indoor temperature of 69 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 05/11/20. 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 stairs/staircase in the family room were barricaded with a child safety gate. 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 01/16/20. 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. Three staff records (S1, S2 and S3) were reviewed at 2:20pm, and staff records reviewed revealed that S2 is missing evidence of negative TB clearance and proof of immunity against the Measles, Pertussis and Influenza. There were no pools or other bodies of water observed.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020
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: NEWTON FAMILY CHILD CARE HOME
FACILITY NUMBER: 483007066
VISIT DATE: 02/19/2020
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Two children's (C1 and C2) records were reviewed at 2:39pm; Notification of Parent’s Rights forms is on file for C2, however, C1's immunization record is not up to date. LPA issued an Advisory Note for this Technical Violation. 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: 02/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020
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: NEWTON FAMILY CHILD CARE HOME
FACILITY NUMBER: 483007066
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/11/2020
Section Cited

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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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This requirement is not met as evidenced by: Based on staff records reviewed revealing at 2:20pm. Staff records reviewed revealed that S2 is missing proof of immunity against the Measles, Pertussis and Influenza. This poses a potential health, safety or personal rights risk to the children in care.
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Email: melchisedeck.augustin@dss.ca.gov
Public Email: cclrpregionalofficegeneral@dss.ca.gov
Fax: 707-588-5099
Type B
03/11/2020
Section Cited

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Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.
This requirement is not met as evidenced by: Based on staff records reviewed at 2:20pm.
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Staff records reviewed revealed that S2 is missing evidenced of negative TB clearance. This poses a potential health, safety or personal rights risk to the children in care.
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Email: melchisedeck.augustin@dss.ca.gov
Public Email: cclrpregionalofficegeneral@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: 02/19/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/19/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3