313621978-8-21-2024-03-CC-LHAM-D8CLLA-20240821085049

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313621978
Report Date: 08/20/2024
Date Signed: 08/21/2024 08:50:57 AM

Document Has Been Signed on 08/21/2024 08:50 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	STAR CARLIN C. COPPIN		FACILITY NUMBER:	313621978
ADMINISTRATOR/ DIRECTOR:	FIFFICK, KRISTINA		FACILITY TYPE:	840
ADDRESS:	150 E. 12TH STREET		TELEPHONE:	(916) 632-8407
CITY:	LINCOLN	STATE: CA	ZIP CODE:	95648
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 60	CENSUS: 34	DATE:	08/20/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	04:15 PM
MET WITH:	Kristina Fiffick		TIME VISIT/ INSPECTION COMPLETED:	05:15 PM

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On August 20, 2024, Licensing Program Analyst (LPA) Lea Habtom arrived to the STAR Carlin C Coppin Elementary school campus and meet with designated staff member Kristina Fiffick for a required annual inspection. At the time of arrival, there were 34 children present being supervised by 4 staff. The facility is located in portable room K. The progam was also utilizing an uncleared space, the library, with 18 children and 2 staff for day care/after school care. All criminal record clearances are associated to the STAR Oakhills #313600444. Facility hours of operation are Monday through Friday from 11:20am - 6pm.

Facility representative was reminded that all adults 18 and over, 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 Child Care Center. 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 toured the classroom, restroom, and outdoor play area. The facility utilizes the school play ground and restrooms. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. The program shares toilet facilities and playground equipment with the school campus Carlin C Coppin. The floors appeared clean throughout the facility. Drinking water was readily available to children both indoors and outdoors. There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector. At least one staff member present today has current Pediatric CPR and First Aid certification. LPA reviewed the Department's inspection authority and discussed any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Report continued on 809-C.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

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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Document Has Been Signed on 08/21/2024 08:50 AM - It Cannot Be Edited

Created By: Lea Habtom On 08/20/2024 at 04:18 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: STAR CARLIN C. COPPIN	FACILITY NUMBER: 313621978
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101161(a)

101161(a) Limitations on capacity: A licensee shall not operate a child care center beyond he conditions and limitations specified on the license, including the capacity limitations. This requirement is not met as evidenced by: 18 children and 2 staff utilizing an uncleared room, the library, prior to licensing approval.
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that the library was utilized as day care/after school care space with no licensing approval which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 08/22/2024
	Plan of Correction
1 2 3 4	Children will be utilizing POD K until approval to operate in the library. An application will be dropped off on 8/21/2024 to the office.

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:

Lea Habtom

LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

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: STAR CARLIN C. COPPIN	FACILITY NUMBER: 313621978
	VISIT DATE: 08/20/2024

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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 Evaluator Manual-Regulation Interpretations and Procedures for Child Care Center Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 513-0301 (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.ht

Staff are encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers.

There was 1 Type A deficiency cited on an 809-D. Title 22 Deficiency has been cited on the attached LIC 809-D. LPA Lea Habtom informed the site supervisor, Kristina Fiffick, that this report dated August 20, 2024, documents 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Lea Habtom informed the site supervisor Kristina Fiffick to provide a copy of this licensing report dated August 20, 2024, that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Appeal Rights given.

Exit interview conducted and report was reviewed with Kristina Fiffick. 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.

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

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

LIC809 (FAS) - (06/04)

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