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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573609149
Report Date: 08/22/2019
Date Signed: 08/22/2019 04:45:32 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:HAYES, PAULAFACILITY NUMBER:
573609149
ADMINISTRATOR:HAYES, PAULAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 374-9356
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY:14CENSUS: 1DATE:
08/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Paula HayesTIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA), Marissa Soto and Licensing Program Manager (LPM) Maria Mayorga met with Licensee's assistant Kailee Coleman for an unannounced Annual inspection. Present in the home were Licensee's assistant supervising 1 child. (Age 3). Assistant stated there are no new residents in the home since licensure, Home is 2 story, 5 bedrooms, 3 bathrooms. Day care hours of operation are Monday-Friday 7:00 AM to 5:30 PM year round with periodic breaks through the year. All adults living in the home have criminal background clearance.
A health and safety inspection was conducted in all areas accessible to children and the following was observed; Off-limits areas are: Upstairs, Garage. LPA observed hazardous items properly stored out of child reach on high shelves in kitchen/laundry room area. There were no hazardous items located in the bathroom. Medication are stored in a closet inaccessible to children. Fire extinguisher, smoke and carbon monoxide detectors are functional. Toys appear to be safe and age appropriate. There were no bodies of water on the property. Outdoor play area is free of hazardous and dangerous conditions and is fenced for supervision.

A sample of children’s files were reviewed. LPA explained that fire and disaster drills are conducted at least once every six months and are documented on a sheet. Current pediatric CPR and first aid certification was verified and expires on 09/2020.


Report continues on 809-C
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Marissa SotoTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
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 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: HAYES, PAULA
FACILITY NUMBER: 573609149
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2019
Section Cited

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...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
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complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. The Licensee and her assistant did not provide proof of this training as required on today's date.
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Type B
08/30/2019
Section Cited

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 ...not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza
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vaccination between August 1 and December 1 of each year. On today's date Licensee did not provide proof of Immunizations as required by law.
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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: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Marissa SotoTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2019
LIC809 (FAS) - (06/04)
Page: 3 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: HAYES, PAULA
FACILITY NUMBER: 573609149
VISIT DATE: 08/22/2019
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LPA discussed the California Child Care Worker: Mandated Reporter Training with the licensee's assistant. The licensee and licensee's assistant must complete the training every two years starting January 1, 2018 and retain proof of completion in the facility file. The training can be found at: mandatedreporterca.com.

LPA also discussed the Smoking ban, Assistant Kailee understands that there are no smoking near or around children. Incidental Medical Services (IMS) policies were also discussed with the licensee's assistant. LPA discussed immunization requirements with the licensee's assistant. IMS policy was discussed with Licensee's assistant. 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.

Lead Poisoning Facts Information Flyer was provided and Licensee's assistant was advised that beginning January 1, 2019 a new law (AB 2370) requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families

LPA advised the licensee's assistant on Safe Sleep Practices and SIDS; the licensee's assistant stated they are understood. She stated she uses play yards for sleeping infants and understand infants cannot sleep in car seats, swings or other items not intended for sleeping. LPA verified the annual fees are current. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the licensee can request to be added to the distribution list to receive Quarterly Updates.

This facility evaluation report was reviewed and discussed with the licensee's assistant. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. Licensee's assistant was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information. Deficiencies were observed on today's date. Please see attached 809-D for citations issued. A copy of this report will remain on file for a period of three years for public review upon request. Appeal rights provided during today's visit.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Marissa SotoTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
LIC809 (FAS) - (06/04)
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