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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573615569
Report Date: 02/06/2020
Date Signed: 02/06/2020 12:32:27 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:MACNEAR, JACQUELINEFACILITY NUMBER:
573615569
ADMINISTRATOR:MACNEAR, JACQUELINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 400-3517
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:14CENSUS: 11DATE:
02/06/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Brianna GarciaTIME COMPLETED:
12:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Amy Silva met with Licensee’s Assistants Colleen Potter and Brianna Garcia for an unannounced random annual inspection. LPA toured areas of the home accessible to children in care. Off-limit areas include Dining Room, Screened Patio, Garage, Master bedroom and Backyard. Licensee acknowledged that children may never enter these off-limit areas. The census included 11 children in care at time of inspection.

LPA observed current CPR/First Aid certificates which expire on 8/29/2021. Mandated reporter certificates are current and will expire 11/17/2020. LPA reviewed 11 children’s files. LPA did not observe fire drills were conducted at least once every six months and documented.

LPA observed that there were hazardous items accessible to children. The bathroom used by children contained a bottle of soap, multiple shampoo and conditioner bottles and a sharp facial razor that were accessible to children in care. Assistant stated there are no weapons in the home. Fire extinguisher, smoke detector and carbon monoxide detector meet regulation. The front yard is fenced and gated. There are no bodies of water observed.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the Licensee can obtain updated licensing information, new regulations and access forms. LPA advised Assistant and Licensee of their responsibility to stay current in regard to new regulations.

Report Continues on 809-C
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy SilvaTELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: MACNEAR, JACQUELINE
FACILITY NUMBER: 573615569
VISIT DATE: 02/06/2020
NARRATIVE
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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.

LPA provided and discussed Effects of Lead Exposure brochure and the revised CDPH 286 form for the documentation of immunization's.

Title 22 Deficiencies have been cited on the attached LIC 809D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's files.

This report was reviewed and discussed with Assistant. A notice of site visit and appeal rights were provided.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy SilvaTELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MACNEAR, JACQUELINE
FACILITY NUMBER: 573615569
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/07/2020
Section Cited

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Operation of a Family Child Care Home- Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
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This requirement is not met as evidenced by: LPA observed a razor in the unlocked bathroom drawer, hand soap under the sink, shampoo and conditioner in unlocked bathroom drawers and shampoo and conditioner bottles in the lower tub area in the bathroom that are accessible to the day-care children. This is an immediate health and safety risk to children in care.
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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: Amy SilvaTELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2020
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MACNEAR, JACQUELINE
FACILITY NUMBER: 573615569
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2020
Section Cited

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Operation of a FCCH - All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. This documentation shall be kept at the family child care home.
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This requirement is not met as evidenced by: LPA did not observe a disaster drill log. This poses a potential health and safety risk to children in care.
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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: Amy SilvaTELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4