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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009521
Report Date: 02/19/2020
Date Signed: 02/19/2020 12:12:01 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:DILLON, LATONYA FCCHFACILITY NUMBER:
483009521
ADMINISTRATOR:DILLON, LATONYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(817) 870-6319
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY:14CENSUS: 6DATE:
02/19/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:42 AM
MET WITH:Latonya DillonTIME COMPLETED:
12:30 PM
NARRATIVE
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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 not all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA interviewed A1 at 9:59am and A1 confirmed that she is an adult that began working at the facility since 02/06/20. According to A1, her duties included supervision of the children, changing diapers and serving preparing and serving snacks to the children. LPA assessed an immediate $500 Civil Penalty because the Licensee did not ensure that A1 obtained a criminal record clearance prior to working at the home. There is currently one adult living in the home.

During today’s inspection the home and grounds were toured. The licensee and one adult (A1) 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 7:00am to 6:00pm, Mon–Fri. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are three bedrooms, one bathroom, kitchen and the garage, and were made inaccessible by children's safety gates. 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 07/13/21. At 9:27am, LPA requested evidence of negative TB clearance for A1, however, the Licensee could not furnish evidence of negative TB clearance for A1. At 9:28am, LPA requested proof of immunity against the Measles, Pertussis and Influenza for A1, however, the Licensee could not furnish required immunization for A1. 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 poison. The facility does not have any stairs/staircase. 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.
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 4
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: DILLON, LATONYA FCCH
FACILITY NUMBER: 483009521
VISIT DATE: 02/19/2020
NARRATIVE
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The licensee has conducted an emergency drill within the past six months, last drill was documented on 01/17/20. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection. The backyard is currently off limits due to yard maintenance. The Licensee stated the children utilize the local community park as the outdoor play area. There were no pools or other bodies of water observed. Two children's (C1 and C2) records were reviewed at 10:33am; Notification of Parent’s Rights forms were on file for C1 and C2, however, C1 and C2 were missing transcribed CDPH 286. 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.

Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.

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 4
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: DILLON, LATONYA FCCH
FACILITY NUMBER: 483009521
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
02/20/2020
Section Cited

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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department
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This requirement is not met as evidenced by: Based on the licensee did not ensure that A1 obtained a criminal record clearance prior to working at the home.This poses an immediate health, safety, or personal rights risk to the children in care.
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The Licensee stated she will produce a a written plan that will detail how she will plans to comply with CCR102370(d)(1).

Email: melchisedeck.augustin@dss.ca.gov
Public Email: cclrpregionalofficegeneral@dss.ca.gov
Fax: 707-588-5099

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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: 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 4
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: DILLON, LATONYA FCCH
FACILITY NUMBER: 483009521
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/02/2020
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 the Licensee not furnishing evidence
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of negative TB clearance for A1 at 9:27am. 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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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 proof of immunity against the Measles, Pertussis and Infleunza for A1. 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: 4 of 4