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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618877
Report Date: 10/20/2022
Date Signed: 10/20/2022 11:59:24 AM

Document Has Been Signed on 10/20/2022 11:59 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:RUNNELS, MARYFACILITY NUMBER:
343618877
ADMINISTRATOR:RUNNELS, MARYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 562-5125
CITY:SACRAMENTOSTATE: CAZIP CODE:
95833
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
10/20/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Runnels, MaryTIME COMPLETED:
12:15 PM
NARRATIVE
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On 10/20/2022, at approximately 11:20 AM, Licensing Program Analyst (LPA) Alize Tillery, made a visit to the facility to conduct a case management inspection. LPA was greeted by Licensee. Upon arrival, LPA observed 7 children supervised by Licensee.


On 10/13/22, Licensee dropped off an Unusual Incident Report to the office, regarding an incident that required Licensee to contact 911, on 10/06/2022. Per LPA review, Licensee did not contact the regional office to inform Licensing of the incident within 24 hour requirement. During today's visit, Licensee stated that she was not aware that a call was to be made, in addition to getting the physical report in, within 7 business day.

During today's inspection, a deficiency for Reporting Requirements is being cited on the following 809D page.

Report and appeal rights were reviewed and provided to Licensee. And a notice of site visit was provided, which must remain posted for 30 days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Alize Tillery
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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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Document Has Been Signed on 10/20/2022 11:59 AM - It Cannot Be Edited


Created By: Alize Tillery On 10/20/2022 at 11:40 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: RUNNELS, MARY
FACILITY NUMBER: 343618877

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2022
Section Cited
HSC
1597.467(b)(1)(B)

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(b)(1) A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of a family day care home of any of the following events:
(B) Any injury to any child that requires medical treatment.
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Licensee will submit correspondence to LPA Tillery, explaining her understanding on the Reporting Requirements regulation.
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This requirement was not met, evidenced by: Licensee did not contact the Regional Office within 24 hours to report an unusual incident, that resulted in medical treatment for a child in care.
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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:Seychelle De Luca
LICENSING EVALUATOR NAME:Alize Tillery
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2022


LIC809 (FAS) - (06/04)
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