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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619743
Report Date: 03/07/2023
Date Signed: 03/07/2023 12:22:06 PM

Document Has Been Signed on 03/07/2023 12:22 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:PETTIT, JENNIFERFACILITY NUMBER:
343619743
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
03/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jennifer PettitTIME COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analysts Erwina Pascual-Golamco and Jennifer Velasco (LPAs) conducted an unannounced annual inspection and met with Licensee Jennifer Pettit (L1). LPAs observed eight children in care with L1. Facility hours of operation are Monday through Friday 7:00 AM to 5:00 PM. Annual facility fees is not current, and L1 was given technical assistance regarding outstanding fees.

L1 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.

Off-limit areas include second story, stairs to the second story, side yards, key locked shed, and garage. L1 acknowledged that children may never enter these off-limit areas.

LPAs conducted a health and safety inspection and observed that the facility is clean, safe, sanitary, and in good repair with proper ventilation. LPAs observed required documents were posted where visible to parents. LPAs observed that the cleaning compounds, medications, and sharp objects were kept inaccessible to children. LPAs observed a 2A-10-BC fire extinguisher which is accessible. LPAs observed the smoke and carbon monoxide detectors are functioning properly. The facility has toys and equipment safe for children to use. The backyard is fenced. LPAs observed a gun safe, but L1 was unable to open the safe to where the weapons and ammunition were stored. A follow up visit will be conducted. Fire extinguisher, smoke detector and carbon monoxide detector meet regulation. No bodies of water were observed.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2023
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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: PETTIT, JENNIFER
FACILITY NUMBER: 343619743
VISIT DATE: 03/07/2023
NARRATIVE
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LPAs observed a current children's roster, fire drill log and safe sleep log. LPAs reviewed children’s files and provided technical assistance re: what is required in each child's file. LPAs observed L1 and assistant (S1) are enrolled in CPR/First Aid training. LPAs provided technical assistance re: current Mandated Reporter certificate for L1 and assistant(s). L1 was reminded the Child Care portion must be completed every two years. LPAs reviewed staff and facility files and observed the required documentation.

LPAs discussed with L1 the safe sleep regulations and the Child Care Licensing Safe Sleep web page athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAS also informed L1 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 Section 102417. 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. LPAs discussed current COVID guidelines with L1 and provided technical assistance.

LPAs provided the Department’s website WWW.CCLD.CA.GOV, so L1 can obtain updated licensing information, new regulations and access forms. LPAs advised L1 of their responsibility to stay current by reviewing PINs on the website.

Tittle 22 Deficiencies have been cited on the attached LIC809. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809 D for parents/guardians of currently enrolled children and newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809 D in each child's files. An exit interview was conducted and this report was reviewed with the facility representative.

A notice of site visit was given to L1 and must remain posted for 30 days. Exit interview was conducted and report was reviewed with L1.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 03/07/2023 12:22 PM - It Cannot Be Edited


Created By: Erwina Pascual-Golamco On 03/07/2023 at 11:16 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: PETTIT, JENNIFER
FACILITY NUMBER: 343619743

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(b)(3)
Staffing Ratio and Capacity
(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (3) More than six and up to eight children, without an additional adult attendant, only if the criteria in
Section 1597.44 of the Health and Safety Code are met.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that the licensee was observed providing care to five preschool children, none of whom are enrolled and attending elementary school, and three infant children, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/08/2023
Plan of Correction
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The licensee stated she will not operate beyond the limitations of her license and will develop a detailed written plan for operating within the limitations of her license including the schedule of the children in care. The licensee stated she will provide this plan to LPA via email by POC due date. erwina.pascual-golamco@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Natalie Dunaway
LICENSING EVALUATOR NAME:Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 03/07/2023 12:22 PM - It Cannot Be Edited


Created By: Erwina Pascual-Golamco On 03/07/2023 at 11:16 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: PETTIT, JENNIFER
FACILITY NUMBER: 343619743

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
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: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in the files of three out of three infants in care, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2023
Plan of Correction
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The licensee stated she will begin using the sleep log and will email the completed sleep logs of all infants in care and email the completed safe sleep logs for a period of not less than two weeks to LPA on or before POC due date.
erwina.pascual-golamco@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Natalie Dunaway
LICENSING EVALUATOR NAME:Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023


LIC809 (FAS) - (06/04)
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