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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573620071
Report Date: 08/09/2021
Date Signed: 08/09/2021 03:37:48 PM

Document Has Been Signed on 08/09/2021 03:37 PM - It Cannot Be Edited

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:TWINKLE LITTLE STAR CENTERFACILITY NUMBER:
573620071
ADMINISTRATOR:INIGUEZ, JOSEFINAFACILITY TYPE:
830
ADDRESS:1401 EAST GUM AVETELEPHONE:
(530) 204-9709
CITY:WOODLANDSTATE: CAZIP CODE:
95776
CAPACITY: 12TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
08/09/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Josefina InguezTIME COMPLETED:
03:45 PM
NARRATIVE
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During the course of a complaint investigation Licensing Program Analyst (LPA) Christopher Jackson observed an infant napping at the facility. The infant's crib contained two blankets while the infant was napping. In addition LPA observed the staff supervising the napping infant was not in direct line of site of the infant.

Deficiencies cited on subsequent 809-D page.

Upon receipt of a Type A citation, LPA discussed with the director the requirement to post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the 12 months.

An exit interview was conducted and Notice of Site Visit was provided and posted.

SUPERVISORS NAME: Sharon Ogbodo
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2021
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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Document Has Been Signed on 08/09/2021 03:37 PM - It Cannot Be Edited


Created By: Christopher Jackson On 08/09/2021 at 02:38 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: TWINKLE LITTLE STAR CENTER
FACILITY NUMBER: 573620071

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/10/2021
Section Cited
CCR
101429(2)

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Sleeping infant(s) shall be directly observed by sight and sound at all times. This regulation was not was meet as evidenced by, LPA observed staff not within direct line of sight while the infant slept. This poses an immediate health and safety risk to children in care.
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Director stated she would conduct a staff meeting. The meeting would discuss supervision with infants while they are napping. In addition LPA provided information pertaining to safe sleep regulations for staff to review.

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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:Sharon Ogbodo
LICENSING EVALUATOR NAME:Christopher Jackson
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/09/2021 03:37 PM - It Cannot Be Edited


Created By: Christopher Jackson On 08/09/2021 at 02:56 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: TWINKLE LITTLE STAR CENTER
FACILITY NUMBER: 573620071

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/31/2021
Section Cited
CCR
101439.1

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Cribs shall be free from all loose articles and objects, including blankets and pillows. This regulation was not meet as evidenced by LPA observed blankets in the crib with napping infant. This poses a potential health and safety risk to children in care.
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Director stated she would conduct a staff meeting. The meeting would discuss safe sleep regulations for infants in care. In addition LPA provided information pertaining to safe sleep regulations for staff to review.

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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:Sharon Ogbodo
LICENSING EVALUATOR NAME:Christopher Jackson
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2021


LIC809 (FAS) - (06/04)
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