343620599-5-4-2023-03-CC-AMAT-CRHUF9-20230504153221

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343620599
Report Date: 05/04/2023
Date Signed: 05/04/2023 03:32:34 PM

Document Has Been Signed on 05/04/2023 03:32 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:	DOLAR, PRISCILLA		FACILITY NUMBER:	343620599
ADMINISTRATOR:	DOLAR, PRISCILLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 515-2030
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95835
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 10	DATE:	05/04/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Priscilla Dolar		TIME COMPLETED:	03:45 PM

NARRATIVE

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On 05/04/2023 at approximately 1:40 PM Licensing Program Analysts (LPAs) Arianna Manabat and Eduardo Barragan met with Licensee Priscilla Dolar for an unannounced annual / one year inspection. During the inspection there was 10 care child and just the Licensee and no assistant provider to help her. All individuals subject to criminal background review have obtained a criminal record clearance. During today's visit, LPAs toured the a two-story home and all areas accessible to children in care. LPAs have noted that the off-limits areas are the following: the storage closet near the garage, the garage, and the entire upstairs. The Licensee stated that there are no firearms or bodies of water on the premises. Facility's hours of operation are 8:30AM to 6:00PM Monday through Friday.

A health and safety inspection was conducted in the areas accessible to children. The house has a working telephone, fully charged fire extinguisher, smoke detector and carbon monoxide detector that meet regulations. LPAs observed all the required postings. LPA's advised the licensee that if there are any poisons at the home, all poisons must be locked with a key lock or combination lock. LPAs observed a screened fireplace within the facility.

Licensee has all of her immunization records current. Children's roster and a current fire drill log were observed. Licensee's CPR/First aid card had an expiration date of May 21, 2023, The Licensee's Mandated Reporter Training was due November, 07, 2024. Licensee understands training must be complete every two years. LPAs observed complete children's files. The last fire drill was conducted May 2023 which was in compliance.

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: http://www.ada.gov/childqanda.htm Report continues on 809C................

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

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: DOLAR, PRISCILLA	FACILITY NUMBER: 343620599
	VISIT DATE: 05/04/2023

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…… Continued from previous 809 page..........

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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] 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.

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.

Based on the inspection, Title 22 Deficiencies have been issued on the attached on the LIC 809-D page. The Licensee was informed that this report dated on 05/05/2023 documents one Type A citations which shall be posted for 30 consecutive days. The Licensee shall also provide a copy of this licensing report 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 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.

A signed Acknowledgement of Receipt of the Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. The Licensee has been provided with appeal rights.

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/04/2023 03:32 PM - It Cannot Be Edited

Created By: Arianna Manabat On 05/04/2023 at 02:59 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: DOLAR, PRISCILLA	FACILITY NUMBER: 343620599
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(d)

Staffing Ratio and Capacity

(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above. The Licensee was alone with ten children in care and did not have an assistant nor any adult in the home who could provide assistance with the ten children in care. Which poses an immediate health, safety risk to persons in care.
	POC Due Date: 05/05/2023
	Plan of Correction
1 2 3 4	The Licensee stated that they will ensure that she has an assistant present in the home whenever she's over capacity. LPA will conduct a follow-up inspection to clear the POC.

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:

Amanda Blesi

LICENSING EVALUATOR NAME:

Arianna Manabat

LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

LIC809 (FAS) - (06/04)

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