343622923-11-5-2024-03-CC-MGON-DAQTP5-20241105135346

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343622923
Report Date: 11/05/2024
Date Signed: 11/05/2024 01:53:56 PM

Document Has Been Signed on 11/05/2024 01:53 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:	CAMPAU, KATHRYN		FACILITY NUMBER:	343622923
ADMINISTRATOR/ DIRECTOR:	CAMPAU, KATHRYN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 662-4145
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95828
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 9	DATE:	11/05/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:35 PM
MET WITH:	Kerissa Montgomery		TIME VISIT/ INSPECTION COMPLETED:	02:15 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	On November 5th, 2024 Licensing Program Analyst (LPA) Mandie Goodwin met with Assistant Kerissa Montgomery, for the purpose of an unannounced required 1-year inspection. No other adults were in the home. All individuals subject to criminal background review have obtained a criminal record clearance. LPA observed there were nine daycare children including three infants under the age of 2, and six children over the age of 2 during inspection. There were no school age children. Facility days and hours of operation are Monday-Friday 7:00am-5:00pm. Assistant stated that there was another assistant with her earlier in the day but they left and another assistant is scheduled to come later in the day. A second assistant arrived at 1:35pm putting facility back into capacity. LPA toured the facility and a health and safety inspection was conducted in all areas accessible to children. The off-limits areas the entire upstairs, garage, laundry room, and both side yards. Assistant acknowledges that children may never enter the off limit areas. LPA observed the required postings, a fully charged fire extinguisher, and functional smoke and carbon monoxide detectors. Per assistant, there are no weapons in the home. There is a pool that is fully fenced with see through mesh at least 5 feet tall. The gate opens away from the pool and self latches. Toxic and hazardous items are inaccessible to children. Outdoor play space is fenced and in good repair. LPA reviewed five children’s files, which were observed to be complete. LPA observed individual pack and plays for infants under 24 months and tight fitted sheets covering the mat. LPA observed infants sleeping with blankets in their pack and plays and that doors to where infants were sleeping were shut. Assistant opened the doors during inspection and removed the blankets from infant cribs. A current children’s roster was observed. Licensee has record of conducting fire drills at least every six months. Per record, last drill was conducted on 10/1/24. LPA provided and reviewed the Family Child Care Home Entrance Checklist. LPA discussed the requirement of renewing CPR and mandated reporter training every 2 years. LPA observed assistant’s CPR and current Mandated Reporter Certificate. (Report continues LIC809-C)

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024

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 11/05/2024 01:53 PM - It Cannot Be Edited

Created By: Mandie Goodwin On 11/05/2024 at 01:08 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: CAMPAU, KATHRYN	FACILITY NUMBER: 343622923
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102425(b)

Infant Safe Sleep

(b) Cribs or play yards shall be free from all loose articles and objects. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above by allowing infants to sleep with blankets which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 11/06/2024
	Plan of Correction
1 2 3 4	Blankets were removed during inspection and LPA cleared citation.

Type A

Section Cited

CCR

102416.5(e)

Staffing Ratio and Capacity

(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above by having 9 children in care with only one adult which is over the capacity specified by a small license which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 11/06/2024
	Plan of Correction
1 2 3 4	About an hour into inspection a second assistant arrived putting facility back into ratio. Licensee will send a statement to LPA that states understanding of the staffing ratio and capacity requirements.

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:

Mandie Goodwin

LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024

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: CAMPAU, KATHRYN	FACILITY NUMBER: 343622923
	VISIT DATE: 11/05/2024

NARRATIVE

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Mandated reporter training can be renewed at mandatedreporterca.com

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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 webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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/resources/child-care-centers/.

Assistant was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. Continued on 809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024

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: CAMPAU, KATHRYN	FACILITY NUMBER: 343622923
	VISIT DATE: 11/05/2024

NARRATIVE

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During the exit interview, the assistant, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. During today’s inspection deficiencies were observed.

LPA Mandie Goodwin informed assistant that this report dated 11/5/24 documents two Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care. Also, LPA Mandie Goodwin informed the assistant to provide a copy of this licensing report that documents any Type A citation(s) 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 signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Exit interview with assistant Kerissa Montgomery was conducted and appeal rights were provided.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024

LIC809 (FAS) - (06/04)

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