343619021-9-8-2023-03-CC-DVAG-CVGT34-20230908142144

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343619021
Report Date: 09/08/2023
Date Signed: 09/08/2023 04:08:34 PM

Document Has Been Signed on 09/08/2023 04:08 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:	QUINONES, MARIA		FACILITY NUMBER:	343619021
ADMINISTRATOR:	QUINONES, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 804-8400
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95838
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	09/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Quinones, Maria		TIME COMPLETED:	03:00 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 12:30 p.m., Licensing Program Analyst (LPA) Pa Dao Vang met with Licensee, Maria Quinones, for the purpose of an unannounced, required - 1 year inspection. There were 5 childcare children were present during inspection supervised by 2 staff. Licensee stated that there are 8 children currently enrolled. Facility hours of operation are 24 hours, Monday thru Friday. Off limits areas include the backyard, and all the bedrooms. All individuals subject to criminal background review have obtained a criminal record clearance. 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. A health and safety inspection was conducted in all areas accessible to children. LPA observed the required postings, a working phone, 3A40-BC fire extinguisher, and functioning smoke alarm and carbon monoxide detectors. Licensee stated that there are no weapons nor poisons in the home. Toxic and hazardous items were appropriately stored, inaccessible to children. LPA reviewed staff file. Licensee is current CPR/First Aid will expire on 3/19/24. LPA observed Mandated reporter training certificate expiring 4/7/2024. LPA Reviewed 7 children's files with all required documents. LPA informed Licensee of location change for regional office and provided updated parents’ rights forms and postings with current address. LPA observed the updated fire drill log with the current date of 8/26/2023. report continued on LC809-C.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

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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Document Has Been Signed on 09/08/2023 04:08 PM - It Cannot Be Edited

Created By: Dao Vang On 09/08/2023 at 01:31 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: QUINONES, MARIA	FACILITY NUMBER: 343619021
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. 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 in 1 out of 1 records, which poses/posed a potential health, safety or personal rights risk to persons in care. LPAs did not observe proof of required immunizations on file at time of inspection.
	POC Due Date: 10/09/2023
	Plan of Correction
1 2 3 4	Licensee stated they shall submit proof of immunization for pertussis, measles, and influenza. Licensee shall maintain documentation of immunization for herself Proof of Correction shall be sent to LPA by POC date: 10/9/2023.

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:

Seychelle De Luca

LICENSING EVALUATOR NAME:

Dao Vang

LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

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: QUINONES, MARIA	FACILITY NUMBER: 343619021
	VISIT DATE: 09/08/2023

NARRATIVE

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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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. LPA discussed about the infant sleep log required for each child under the ages of 1years old. Licensee must checking and documenting each infant sleeping every 15 minutes.

This provider is not currently providing Incidental Medical Services IMS services to children in care. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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: https://www.ada.gov/childqanda.htm.

During the exit interview, the LICENSEE Quinones, Maria, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the licensee, Licensee Quinones, Maria. A Notice of Site Visit was given and must remain posted for 30 days. 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/inspection-process.

In the areas that were evaluated, 1 Type B deficiency was cited during inspection. A copy of this report, appeal rights, and 1597.622 (c) regulation was printed and provided to the Licensee.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

LIC809 (FAS) - (06/04)

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