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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621402
Report Date: 06/12/2023
Date Signed: 06/13/2023 08:28:15 AM

Document Has Been Signed on 06/13/2023 08:28 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:DURAN, AZUCENAFACILITY NUMBER:
343621402
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
06/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:AzucenaTIME COMPLETED:
04:15 PM
NARRATIVE
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On 06/12/2023 Licensing Program Analyst (LPA) Corina Beckby, conducted an unannounced annual inspection and met with Licensee, Azucena Duran. Form (LIC 126), Entrance Checklist for Family Child Care Homes, was provided to Licensee. Present in the facility was Licensee and her husband (her assistant) caring for 6 children (ages: 3,4,6,2,2,2 years old). Facility hours of operation are Monday-Friday 7:00 am to 6:00 pm. LPA verified the annual fees are current.

All individuals subject to criminal background review have obtained a criminal record clearance. Licensee stated no new residents have moved into the home. 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. Upon entry, LPA observed the posting of the facility license, Emergency Disaster Plan, Earthquake Preparedness Checklist and Notification of Parent Rights. Off-limit rooms are: living room, entire 2nd floor, garage, pantry, and front yard. Off-limits areas will remain inaccessible to children by closed doors, gates, and/or supervision. The licensee acknowledges that she must contact LPA prior to making an off-limits area on-limits and vice versa.

Continued on LIC 809C...
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 06/13/2023 08:28 AM - It Cannot Be Edited


Created By: Corina Beckby On 06/12/2023 at 03:12 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: DURAN, AZUCENA
FACILITY NUMBER: 343621402

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review , the licensee did not comply with the section cited above in 2 out of 6 chilren's files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/12/2023
Plan of Correction
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Licensee will send copies of missing immunizations to LPA via email by due date
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in which Licensee did not have un updated facility roster, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/12/2023
Plan of Correction
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Licensee will send an updated roster to LPA via email by due date.
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:Bettina Engelman
LICENSING EVALUATOR NAME:Corina Beckby
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2023


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Document Has Been Signed on 06/13/2023 08:28 AM - It Cannot Be Edited


Created By: Corina Beckby On 06/12/2023 at 03:12 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: DURAN, AZUCENA
FACILITY NUMBER: 343621402

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in 6 out of 6 children's files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/12/2023
Plan of Correction
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Licensee will give parents a liability forn and send pictures of all signed forms to LPA via Email by due date.
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:Bettina Engelman
LICENSING EVALUATOR NAME:Corina Beckby
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2023


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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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: DURAN, AZUCENA
FACILITY NUMBER: 343621402
VISIT DATE: 06/12/2023
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Cleaning agents and detergents are made inaccessible to children. Poison, toxic and hazardous times are made inaccessible to children. Personal medication is stored in the kitchen in a top cabinet. Functioning smoke and carbon monoxide detectors were observed in the home and meet Title 22 regulations. LPA observed a 2-A-10-BC fire extinguisher. Sharp utensils are stored in a top kitchen cabinet. Toys appear to be safe and in working order. Licensee states there are no weapons in the home. The fireplace in the home has tempered glass and is not in use during business hours. Outdoor play space is fully fenced. There are no bodies of water on the premises.

LPA reviewed 6 children’s files. Preventative health and current pediatric CPR and first aid training was verified, and CPR expires 08/13/2024. Licensee understands the training must be completed once every two years, and training is accessible at www.mandatedreporterca.com.

Licensee currently has no children enrolled that require IMS. Licensee has submitted one plan for IMS to the department and is working with the parents of the other child. Licensee acknowledges that a Plan for Providing IMS must be submitted to the Department. 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.

Licensee has 0 infants currently enrolled and is aware that an (LIC9227) Individual Infant Sleeping Plan, for infants under 12 months and sleep logs for all infants in care under 24 months need to be maintained in children’s files. LPA discussed the safe sleep regulations with Licensee and provided the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA provided example of sleep log and LIC9227 form.

Continued on LIC809C...
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023
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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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: DURAN, AZUCENA
FACILITY NUMBER: 343621402
VISIT DATE: 06/12/2023
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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 encouraged Licensee to visit the department website at WWW.CCLD.CA.GOV for information regarding childcare updates, forms, regulations and legislation pertaining to family childcare homes.

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.



Licensee asked about changing capacity to a large daycare. LPA stated she would send her the information via email.

LPA Beckby informed licensee, Azucena Duran, that this report dated June 12, 2023, documents Type B citations issued during today's inspection this poses a potential risk to the health, safety, of children in care.

An Exit interview was conducted, and the report was reviewed with Licensee, Azucena Duran. LPA posted a notice of site visit. Licensee understands the Notice must remain posted for 30 days and that a failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights were provided. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023
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