313601246-6-27-2023-03-CC-MGAO-CT7U3C-20230627151318

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313601246
Report Date: 06/27/2023
Date Signed: 06/27/2023 03:13:25 PM

Document Has Been Signed on 06/27/2023 03:13 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	LOWRY, ROBYN		FACILITY NUMBER:	313601246
ADMINISTRATOR:	LOWRY, ROBYN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 305-5773
CITY:	COLFAX	STATE: CA	ZIP CODE:	95713
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 11	DATE:	06/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Robyn Lowry		TIME COMPLETED:	03:20 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	At 1:15pm on 6/27/2023, Licensing Program Analyst (LPA) Matthew Gallo met with Licensee Robyn Lowry for the purpose of an unannounced required 1-year inspection. Licensee states no others are present in the home today except for her assistant, who was present for the inspection. Upon arrival, LPA observed a total census of 11 children, including 1 infant and 10 preschool children. Licensee guided LPA on a tour of the facility, and a health and safety inspection was conducted in all areas accessible to children. Off-limit areas include: garage, master bedroom, bedroom 1, bathroom 1, laundry room, living room, dining room, and garden area. Licensee acknowledged that children must never enter these areas. LPA observed the required postings, a working phone, 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors. Per Licensee, there are no weapons in the home. Bodies of water are properly barricaded with 5ft fence that does not obstruct view and features a self-latching gate that opens outward. Toxic and hazardous items are inaccessible to children. Fireplace is barricaded to prevent access by children. There are no stairs in the home. Outdoor play space is fenced. 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. LPA reviewed 11 children’s files and observed them to be complete. A current roster is being maintained and fire and disaster drills are documented. Current CPR and First Aid certification was verified and expires 8/2025, and AB 1207 Mandated Reporter Training was verified for the Licensee and expires 8/2025. (Report continues LIC809-C)

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LOWRY, ROBYN	FACILITY NUMBER: 313601246
	VISIT DATE: 06/27/2023

NARRATIVE

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Licensee stated she places infant children on their backs when they are napping. LPA observed individual sleep plans for infants under 12 months. However, licensee could not produce proof of 15 minute sleep checks for all infants under 24 months.

LPA further discussed the safe sleep regulations with licensee and referenced 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

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. When any IMS is provided an updated Plan of Operation that includes 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

Title 22 deficiencies are cited on the subsequent pages of this report.

Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiencies for 30 days 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. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee.

Exit interview conducted and report was reviewed with the licensee Robyn Lowry. Appeal rights and a notice of site visit were provided, the latter of which must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/27/2023 03:13 PM - It Cannot Be Edited

Created By: Matthew Gallo On 06/27/2023 at 02:47 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LOWRY, ROBYN	FACILITY NUMBER: 313601246
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: 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 by being unable to produce 15 minute sleep checks for infants in care. This poses a potential health, safety, or personal rights risk to persons in care.
	POC Due Date: 07/07/2023
	Plan of Correction
1 2 3 4	Licensee will send LPA Gallo proof of 15 minute sleep logs for the period of 6/28/2023 to 7/7/2023 to ensure compliance with regulation

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:

Keven Peters

LICENSING EVALUATOR NAME:

Matthew Gallo

LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023

LIC809 (FAS) - (06/04)

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