<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493007238
Report Date: 10/16/2019
Date Signed: 10/16/2019 11:48:31 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:CHADWICK, DEBRA FCCHFACILITY NUMBER:
493007238
ADMINISTRATOR:CHADWICK, DEBRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 544-7244
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:14CENSUS: 8DATE:
10/16/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:34 AM
MET WITH:Debra ChadwickTIME COMPLETED:
12:02 PM
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
Licensing Program Analyst (LPA) Amy Strother made an unannounced Plan of Correction (POC) inspection at the facility for a deficiency that was cited on 09/03/19. The Licensee was cited for not having current pediatric CPR/First aid certificates for herself and two assistants, Staff 1-2 (S1-S2), . The Licensee's Plan of Correction was due on 10/03/2019. Although the licensee did submit a certificate on 09/11/19 for herself and on 09/23/19 S1 and S2, the course did not meet Community Care Licensing’s (CCL’s) requirements for approved training programs for Pediatric First Aid/CPR. LPA Strother notified licensee that the certificates submitted did not meet the plan of correction via voicemail to the facility on 09/24/19 and requested a return call. Licensee did not return LPA’s call and has not submitted her updated POC to the Department. During today's inspection, LPA met with the Licensee, Debra Chadwick and discussed the purpose of the inspection with the Licensee. Licensee provided LPA with a cell phone number, stating that it is a better number to call. LPA observed nine children in the care, supervised by the Licensee and two assistants. LPA requested certificates for Pediatric First Aid/CPR that are from an approved training program for the Licensee and S1-S2. The Licensee stated that she does not have certificates for Pediatric First Aid/CPR that are from an approved training program for the Licensee and S1-S2. LPA logged into the CCL website and reviewed the list of approved venders. Licensee looked online at options for classes and will consult her assistants to come up with a date that fits their schedules and submit verification of class sign up to LPA.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.
Notice of Site Visit shall be posted for 30 days from today's visit.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: CHADWICK, DEBRA FCCH
FACILITY NUMBER: 493007238
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/16/2019
Section Cited

1
2
3
4
5
6
7
102416(c) Personnel Requirements. The Licensee and other personnel as specified shall complete training on preventive health practices including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This requirement is not met as evidenced by:

8
9
10
11
12
13
14
Based on interview, the licensee and assistants (S1 & S2) failed to complete Pediatric First Aid/CPR training from an approved training program and do not have a current certificates. Licensee's and Assistants (S1 & S2) Pediatric First Aid/CPR training certificate expired on 07/2019. This poses a potential Health & Safety risk to the children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2