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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483007966
Report Date: 03/06/2020
Date Signed: 03/06/2020 02:13:20 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:PLUMP, SHIRLEY FCCHFACILITY NUMBER:
483007966
ADMINISTRATOR:PLUMP, SHIRLEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 246-6596
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY:14CENSUS: 1DATE:
03/06/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Shirley PlumpTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Melchisedeck Augustin made an unannounced case management inspection at the facility, in response to the Licensee's overdue Plan of Corrections (POC). On 01/06/20, the Licensee was cited for not having her AB 1207 Mandated Reporter Training certificate, and proof of immunity against the Pertussis and Influenza. The Licensee's POC were due respectively on 01/27/20 and 02/18/20; and the Department has not received the Licensee's Plan of Corrections. During today's inspection, LPA met with Licensee Shirley Plump and LPA discussed the purpose of the inspection with the Licensee. During today's inspection, LPA requested proof of immunity against the Pertussis and Influenza; and the AB 1207 Mandated Reporter Training certificate. At 1:55pm, the Licensee stated that she has not completed the online AB 1207 Mandated Reporter Training certificate, however, she will complete the training the weekend of 03/07/20. LPA povided online address www.mandatedreporterca.com, for the Licensee to complete the online training. The Licensee stated that she could not furnish her proof of immunity against the Pertussis and Influenza, however, the Licensee stated she will visit her medical provider to obtain her proof of immunity against the Pertussis and Influenza.

This report was reviewed and discussed with the Licensee. Notice of Site Visit shall be posted for 30 days from today's inspection.

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: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
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,
, CA

FACILITY NAME: PLUMP, SHIRLEY FCCH
FACILITY NUMBER: 483007966
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/18/2020
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 reporter training every two years following the date on which he or she
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completed the initial mandated reporter training.
This requirement is not met as evidenced by: Based on the Licensee not furnishing her AB 1207 Mandated Reporter Training certificate. This poses a potential health, safety, or personal rights risk to children in care.
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Email: melchisedeck.augustin@dss.ca.gov
Fax: 707-588-5099
Public Email: cclrpregionalofficegeneral@dss.ca.gov
Type B
03/20/2020
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 the Licensee not furnishing her proof of immunity against the Pertussis and Influenza to LPA. This poses a potential, health, safety, or personal rights risk to children in care.
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Email: melchisedeck.augustin@dss.ca.gov
Fax: 707-588-5099
Public Email: cclrpregionalofficegeneral@dss.ca.gov
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: 03/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2020
LIC809 (FAS) - (06/04)
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