585407073-12-2-2022-13-CC-ELAD-CLQPQ2-20221202103025

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 585407073
Report Date: 12/02/2022
Date Signed: 12/02/2022 10:30:46 AM

Document Has Been Signed on 12/02/2022 10:30 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	MARTINEZ, LAUREL FAMILY CHILD CARE HOME		FACILITY NUMBER:	585407073
ADMINISTRATOR:	MARTINEZ, LAUREL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 960-8343
CITY:	PLUMAS LAKE	STATE: CA	ZIP CODE:	95961
CAPACITY:	14	CENSUS: 8	DATE:	12/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Angela Williams, Assistant		TIME COMPLETED:	10:45 AM

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 12/2/22 at 9:06am, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Erica Laird. At 9:40am the home was toured inside and outside. The assistant, Angela Williams, was supervising 8 children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 7:00am-4:30pm Mon-Thurs, and 7:00am-3:30pm, on Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the master bedroom, 2nd bedroom, laundry room, garage, back yard, side yard, and front yard, and were made inaccessible by door knob covers and baby gate. The children use the park as the outdoor play area and it not fully fenced. Assistant was reminded children need to have 100% supervision while outside in unfenced area. There were no pools or other bodies of water observed in the yard. Assistant Angela Williams was unable to locate staff and children's files. Licensee is unavailable and unable to provide documentation. There are currently 3 adults living in the home. The facility representative 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.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Erica Laird	TELEPHONE: 530-895-5045
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022

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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: MARTINEZ, LAUREL FAMILY CHILD CARE HOME	FACILITY NUMBER: 585407073
	VISIT DATE: 12/02/2022

NARRATIVE

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LPA discussed the safe sleep regulations with facility representative 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 facility representative 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.

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

The following deficiencies were cited (see LIC 809D):

Exit interview conducted and report was reviewed with the facility representative, Angela Williams.

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. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Erica Laird	TELEPHONE: 530-895-5045
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/02/2022 10:30 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: MARTINEZ, LAUREL FAMILY CHILD CARE HOME	FACILITY NUMBER: 585407073
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/02/2022

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 interview, LPA discovered assistant has not taken her mandated reporter traininig which poses a potential health, safety or personal rights risk to persons in care. . Assistant was informed that this is a required training and must be completed as soon as possible and renewed every two years.
	POC Due Date: 12/16/2022
	Plan of Correction
1 2 3 4	Assistant agreed to take the required mandated reporter training by 12/16/22 and provide proof of completion to CCL.

Type B

Section Cited

CCR

102370(k)(1)

Criminal Record Clearance

(k) The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of employees, volunteers that require fingerprinting and non-client adults residing in the facility. (1) Documentation shall be available for inspection by the Department. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview with assistant LPA discovered CPR/1st Aid is expired and assistant was unable to locate expired card which poses a potential health, safety or personal rights risk to persons in care. Licensee reminded Assistant of the importance of keeping all required trainings current and documentation in an accessible location.
	POC Due Date: 01/02/2023
	Plan of Correction
1 2 3 4	Assistant agreed to enroll in an EMSA approved CPR and First Aid course as soon as possible and will provide CCL with proof of completion by 1/2/23.

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: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Erica Laird	TELEPHONE: 530-895-5045
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 12/02/2022 10:30 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: MARTINEZ, LAUREL FAMILY CHILD CARE HOME	FACILITY NUMBER: 585407073
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview LPA was informed assistant did not know where documentation (children’s files/staff files) were kept. Licensee was unavailable and unable to tell here where to find them. LPA discussed the importance of knowing the location of all documentation whenever watching children.
	POC Due Date: 01/02/2023
	Plan of Correction
1 2 3 4	Assistant agreed to send copies of required children's documentation to CCL by 1/2/23.

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: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Erica Laird	TELEPHONE: 530-895-5045
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022

LIC809 (FAS) - (06/04)

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