573621619-2-22-2023-53-CC-ETJA-CPASW9-20230222131359

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 573621619
Report Date: 02/22/2023
Date Signed: 02/22/2023 01:14:06 PM

Document Has Been Signed on 02/22/2023 01:14 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:	WILLIAMS, LADONNA		FACILITY NUMBER:	573621619
ADMINISTRATOR:	WILLIAMS, LADONNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 917-5019
CITY:	WEST SACRAMENTO	STATE: CA	ZIP CODE:	95691
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS:	DATE:	02/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Ladonna Williams		TIME COMPLETED:	01:30 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 02/22/2023, Licensing Program Analyst (LPA) Erwin Tjhia met with Licensee, Ladonna William for the purpose of an unannounced annual inspection. There were 6 preschoolers and 2 infants present at the time of inspection. Licensee's assistant was also present during the inspection. Licensee's operating hours are Monday through Friday from 7 AM. to 4:40 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 Three rooms on second floor, laundry and garage. Off limit areas are being made inaccessible by closed locked doors and baby gates. During today inspection, licensee requested to have the entire upstair to be off-limit. LPA observed the required postings and a working phone. 2A10BC fire extinguisher meets regulations. LPA observed smoke and carbon monoxide detectors, and verified they were both functional. LPA toured the kitchen area and verified knives and cleaners were inaccessible to children in care. Licensee stated there are no weapons in the home. The in-ground pool area is fenced per Title 22 regulations and LPAs observed the gate to self-close and self-latch. There are locked windows or doors that provide direct access into the pool area. LPAs discussed supervision regarding pools. Outdoor play space is fenced. LPA observed living room area with age appropriate toys for children. LPA observed a restroom and verified that hazardous and toxic items were inaccessible to children in care. Report Continue on 809-C

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

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: WILLIAMS, LADONNA	FACILITY NUMBER: 573621619
	VISIT DATE: 02/22/2023

NARRATIVE

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LPA 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.

Children's files were reviewed. Emergency information and required immunization records were on file. LPA observed a copy of LIC 9227 Individual Sleeping Plan, for infants under 12 months, for licensee during today's inspection. LPA observed a current roster and documentation that a fire drill is conducted at least once every six months. 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 08/2023 and Child Care Provider Mandated Reporter certification was verified and expires 04/2023. Licensee's staff was not able to provide proof of immunizations for MMR and Tdap. This is a potential risk to health and safety of children in care. Type B deficiencies are cited

LPA verified the annual fees are current.

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

Deficiencies are on the next page. Notice of site visit and appeal right was provided.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/22/2023 01:14 PM - It Cannot Be Edited

Created By: Erwin Tjhia On 02/22/2023 at 12:49 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: WILLIAMS, LADONNA	FACILITY NUMBER: 573621619
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. 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 as the Licensee's staff was not able to provide proof of immunizations for MMR and Tdap which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 03/08/2023
	Plan of Correction
1 2 3 4	Licensee will send LPA the proof of the staff's immunization for MMR and Tdap by 03/08/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Bettina Engelman

LICENSING EVALUATOR NAME:

Erwin Tjhia

LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC809 (FAS) - (06/04)

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