<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500090
Report Date: 10/14/2021
Date Signed: 10/14/2021 12:07:42 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:GORHAM, MEGHANFACILITY NUMBER:
574500090
ADMINISTRATOR:GORHAM, MEGHANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 721-7198
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY:14CENSUS: 10DATE:
10/14/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Meghan GorhamTIME COMPLETED:
12:06 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 10/14/2021 at 9:09am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Meghan Gorham for an Unannounced Annual Inspection. Present during the inspection was the Licensee, her two (2) fingerprint cleared assistants M. Fontanilla and M. Whitaker, and ten (10) preschool children. Licensee lives in the home with her two children, age thirteen (13) and eleven (11). Licensee’s home was toured for a health and safety inspection. The facility operates from 8:30am – 4:00pm.

ON LIMITS AREA: Great Room, Kitchen, Living Room, Office, Media Room, Bathroom, Nook and Backyard


OFF LIMITS AREA: Entire 2nd Floor, Garage and Pool Area of the Backyard
ISOLATION AREA: Living Room

The facility is a two story home owned by the Licensee. The inside and outside of the home are observed to be neat and clean with ample age appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. The fireplace in the living room has been screened off and made inaccessible to the children in care. There is a pool in the backyard that has been made inaccessible with a 5ft mesh fence. The door is self-closing, with a latch 6 inched high, and opens away from the pool. There is also an outdoor kitchen that is not in use and has been blocked with furniture making it inaccessible to the children in care.

The home has one (1) fully charged 2A10BC fire extinguisher on the wall in the great room. There is one (1) working smoke detector in the hallway leading to the media room, the great room, the media room and the office. The working carbon monoxide detector is located in the hallway leading to the media room. The home is equipped with central heating and air for proper ventilation. Licensee has stated that there is are two (2) dogs and no firearms in the home.

Continued on LIC809-C
SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 340-6032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
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 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: GORHAM, MEGHAN
FACILITY NUMBER: 574500090
VISIT DATE: 10/14/2021
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
26
27
28
29
30
31
32
The Licensee’s Health and Safety training has been completed. Pediatric CPR & First Aid training has been completed and expires 9/2023. Licensee’s Mandated Reporter training has expired as of 8/26/2021 (see LIC809-D). All required forms are posted and visible for public view by the front door. LPA obtained the children’s files and her helper’s files and the facility roster. All children's files and roster were complete. Both assistants’ files were incomplete. LPA advised Licensee on what the regulations are regarding the proper documentation (see LIC809-D). LPA obtained the fire/disaster drill log. Log is complete with last drill logged 6/12/2021.

Licensee was reminded that California Law requires licensees to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com.

Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. The licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

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

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. Continued on LIC809-C

SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 340-6032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
LIC809 (FAS) - (06/04)
Page: 2 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: GORHAM, MEGHAN
FACILITY NUMBER: 574500090
VISIT DATE: 10/14/2021
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
26
27
28
29
30
31
32
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.

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/process.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Meghan Gorham.
SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 340-6032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
LIC809 (FAS) - (06/04)
Page: 3 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: GORHAM, MEGHAN
FACILITY NUMBER: 574500090
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day 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 complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

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 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/28/2021
Plan of Correction
1
2
3
4
Licensee and both assistants will complete the Mandated Reporter training. Licensee will send LPA Pringle proof of completion by POC due date.
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

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 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/28/2021
Plan of Correction
1
2
3
4
Licensee will ensure completion of both assistants files with the proper documents. Licensee will send LPA proof of correction by POC due date.
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 DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 340-6032
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5