313601246-8-14-2024-03-CC-MGAO-D85QUB-20240814122827

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313601246
Report Date: 08/14/2024
Date Signed: 08/14/2024 12:28:44 PM

Document Has Been Signed on 08/14/2024 12:28 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/ DIRECTOR:	LOWRY, ROBYN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 305-5773
CITY:	COLFAX	STATE: CA	ZIP CODE:	95713
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 12	DATE:	08/14/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Robyn Lowry		TIME VISIT/ INSPECTION COMPLETED:	12:35 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 9:30am on 8/14/2024, Licensing Program Analyst (LPA) Matthew Gallo met with Licensee Robyn Lowry for the purpose of an unannounced required annual inspection. Upon arrival, LPA observed a total census of 12 children consisting of 2 infants, 9 preschool children, and 1 school aged child. Licensee's assistant (Staff 1) was present for the inspection. Licensee guided LPA on a tour of the facility, and a health and safety inspection was conducted in all areas accessible to children. Prior to today's inspection, the off limit areas included the garage, master bedroom, bedroom 1, bathroom 1, laundry room, living room, dining room, and garden area. During today's inspection, licensee stated that they intend to move the master bedroom to an on-limits area where children will nap. LPA inspected the space and observed it to meet all required regulations. There is an attached master bathroom that will remain off-limits, and licensee acknowledges that it must be made inaccessible to children. Moving forward, updated off-limit areas are: garage, master bathroom, 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. A pool is properly barricaded with 5ft fence that does not obstruct view and features a self closing and self-latching gate that opens outward from the body of water. Toxic and hazardous items are inaccessible to children. LPA observed pesticide to be stored in the garage, which features a key-locked door. Licensee acknowledges that this door must always remained locked during day care hours. Fireplace is barricaded to prevent access to children. There are no stairs in the home. Outdoor play space is fenced. Report continues on LIC809-C

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

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: 08/14/2024

NARRATIVE

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Criminal record clearances were verified. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA reviewed 12 children’s files, 9 of which were missing signed copies of licensing form LIC282, Affidavit Regarding Liability Insurance For Family Child Care Homes. During LPA's review of personnel files, licensee could not produce proof of immunizations for influenza, measles, and pertussis for Staff 1. 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.

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-andresources/safe-sleep as an additional resource. LPA also informed licensee 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Report continues on 809-C

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

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: 08/14/2024

NARRATIVE

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

Exit interview conducted and report was reviewed with the licensee, Robyn Lowry. A notice of site visit was given and must remain posted for 30 days. Appeal rights were provided.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/14/2024 12:28 PM - It Cannot Be Edited

Created By: Matthew Gallo On 08/14/2024 at 11:51 AM

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: 08/14/2024

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 interview and record review, the licensee did not comply with the section cited above due to not being able to produce proof of influenza, pertussis, or measles immunization for their assistant, Staff 1. This poses a potential health, safety, or personal rights risk to persons in care.
	POC Due Date: 09/13/2024
	Plan of Correction
1 2 3 4	Licensee will provide LPA Gallo copies of influenza, pertussis, and measle immunizations for Staff 1 by the POC due date. Documents can be provided by email at matthew.gallo@dss.ca.gov or by text at 916-208-3734.

Type B

Section Cited

CCR

102417(m)(3)

Operation of A Family Child Care Home

(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state. 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 in 9 out of 12 children's files reviewed by LPA, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/13/2024
	Plan of Correction
1 2 3 4	Licensee will provide LPA Gallo signed copies of missing LIC282s by the POC due date. Documents can be provided by email at matthew.gallo@dss.ca.gov or by text at 916-208-3734.

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: 08/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

LIC809 (FAS) - (06/04)

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