573607523-1-25-2022-53-CC-CHUR-CAZTD4-20220125133743

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 573607523
Report Date: 01/25/2022
Date Signed: 01/25/2022 05:35:06 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	MEZA, ROSA		FACILITY NUMBER:	573607523
ADMINISTRATOR:	MEZA, ROSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 669-7670
CITY:	WOODLAND	STATE: CA	ZIP CODE:	95776
CAPACITY:	14	CENSUS: 3	DATE:	01/25/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Licensee, Rosa Meza		TIME COMPLETED:	01:45 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	On January 25, 2021, Licensing Program Analysts (LPAs) Chayntel Hunter and Katy Maestas met with Licensee, Rosa Meza for the purpose of an unannounced annual inspection. There were three children present at the time of inspection. Licensee's assistant was also present during the inspection. Licensee's operating hours are Monday through Sunday from 6:00 AM. to 6:00 PM. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include all the bedrooms of the home, laundry room, the garage. During the inspection Licensee made her backyard off limits and will section off a part of the backyard to make accessible to children. Once the area is done, LPA Hunter will conduct an inspection to ensure hazardous items are inaccessible to children in care. Off limit areas are being made inaccessible by closed locked doors. LPAs observed the required postings and a working phone. 3B40BC fire extinguisher meets regulations. LPAs observed smoke and carbon monoxide detectors, and verified they were both functional. LPAs toured the kitchen area and verified knives and cleaners were inaccessible to children in care. Report continues on 809-C.

SUPERVISOR'S NAME: Justin L Denton	TELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2022

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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MEZA, ROSA	FACILITY NUMBER: 573607523
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 7 files, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/25/2022
	Plan of Correction
1 2 3 4	Licensee explaiened she will assist parents in completing all records to be maintained for children according to Title 22 regulations. Licensee will submit a copy to LPA Hunter at chayntel.hunter@dss.ca.gov.

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 2 files, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/25/2022
	Plan of Correction
1 2 3 4	Licensee explaiened she will assist parents in completing all records are maintained for children according to Title 22 regulations. Licensee will submit a copy to LPA Hunter at chayntel.hunter@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: Justin L Denton	TELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2022

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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MEZA, ROSA	FACILITY NUMBER: 573607523
	VISIT DATE: 01/25/2022

NARRATIVE

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Licensee stated there are no weapons in the home. There are no bodies of water on the premises. Outdoor play space is fenced. LPAs observed play room area with age appropriate toys for children. LPAs observed a restroom and verified that hazardous and toxic items were inaccessible to children in care.

LPAs discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. LPA discussed the requirement to check and log infant napping every 15 minutes. LPAs provided a copy of LIC 9227 Individual Sleeping Plan, for infants under 12 months, for licensee during today's inspection.

Children's files were reviewed. LPAs did not observe Emergency information and required immunization records on file for 2 out of 7 files reviewed. LPAs observed a current roster. Licensee's immunization records for measles (MMR), pertussis (Tdap), and the flu are available in the facility file. Current in-person EMSA pediatric CPR and First Aid certification was verified and expires 09/2023 and Child Care Provider Mandated Reporter certification was verified and expires 02/2023.

LPA verified the annual fees are current.

Report continues on 809-C.

SUPERVISOR'S NAME: Justin L Denton	TELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2022

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MEZA, ROSA	FACILITY NUMBER: 573607523
	VISIT DATE: 01/25/2022

NARRATIVE

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This provider is not currently providing IMS services to children in care. Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) policy was discussed. 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 (USDOJ) 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, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Exit interview conducted and report was reviewed with the licensee. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for childcare updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. Licensee's signature on this form acknowledges receipt of this form. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

The following deficiencies were cited on the subsequent 809-D page.

SUPERVISOR'S NAME: Justin L Denton	TELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2022

LIC809 (FAS) - (06/04)

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