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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409183
Report Date: 09/05/2024
Date Signed: 09/05/2024 05:06:47 PM

Document Has Been Signed on 09/05/2024 05:06 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:WRIGHT, DANIELLEFACILITY NUMBER:
073409183
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 22CENSUS: 7DATE:
09/05/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Danielle WrightTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Cherie Acosta and Kareeca Sykes conducted an unannounced Case Management inspection. LPAs first met with Naiomi Simpson and Antanishia Simpson. Licensee arrived to the home shortly after LPAs arrival. There were 3 preschool aged children, 3 school aged children and 1 infant in care during the inspection.

The following violations were observed during the inspection:

Naiomi Simpson and Antanishia Simpson both live in the home and were providing care for children when LPAs arrived. Naiomi Simpson and Antanishia Simpson do not have criminal record clearance.
A civil penalty of $100.00 is assessed each for Naiomi Simpson and Antanishia Simpson for not having criminal record clearance.

During the inspection LPAs observed an infant sleeping in a swing.
Licensee did not have a current up to date facility roster.

The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall 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 next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

Notice of Site Visit was provided and must be posted for 30 days.
Exit interview and report reviewed with Danielle Wright.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2024
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 3
Document Has Been Signed on 09/05/2024 05:06 PM - It Cannot Be Edited


Created By: Cherie Acosta On 09/05/2024 at 02:36 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
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: WRIGHT, DANIELLE
FACILITY NUMBER: 073409183

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/06/2024
Section Cited
CCR
102370(d)(1)

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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:Obtain a California clearance or a criminal record
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Licensee shall ensure Naiomi Simpson and Antanishia Simpson are fingerprinted by 9/6/24. Licensee shall provide a receicpt as proof of obtaining fingerprints by 9/6/24.
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exemption as required by the Department. This requirement was not met as evidenced by: adults assistants living in the home do not have criminal record clearance which poses an immidiate risk to the health and safety of children in care.
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Type A
09/06/2024
Section Cited
CCR102425(i)

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Infant Safe Sleep.If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible. This requirement was not met as evidenced by:
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Licensee shall review the regulations and submit a letter to CCL by 9/6/24 ensure that she understands and will remain in compliance.
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LPAs observed an infant sleeping in a swing during the inspection which poses an immediate risk to the health and safety of children in care.
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• Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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:Sherelle Johnson
LICENSING EVALUATOR NAME:Cherie Acosta
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 09/05/2024 05:06 PM - It Cannot Be Edited


Created By: Cherie Acosta On 09/05/2024 at 03:19 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
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: WRIGHT, DANIELLE
FACILITY NUMBER: 073409183

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/13/2024
Section Cited
HSC
1596.841

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Current roster of children provided care in facility required.Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or
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Licensee shall provide a current up to date roster to CCL by 9/13/24.
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 guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request. This requirement was not met as evidenced by: licensee did not have a current roster during inspection which poses a potential risk to the health and safet of children in care
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• Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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:Sherelle Johnson
LICENSING EVALUATOR NAME:Cherie Acosta
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2024


LIC809 (FAS) - (06/04)
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