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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623540
Report Date: 07/27/2021
Date Signed: 07/27/2021 10:59:08 AM

Document Has Been Signed on 07/27/2021 10:59 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:MITCHELL, LISAFACILITY NUMBER:
343623540
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
07/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lisa MitchellTIME COMPLETED:
11:10 AM
NARRATIVE
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On July 27, 2021 at 9:45 AM, Licensing Program Analyst (LPA) Washington met with licensee Lisa Mitchell for the purpose of an annual required 1 year inspection. The facility’s days and hours of operation are Monday- Thursday from 8:30 AM to 3:00 PM. Licensee stated that her program is mainly operated in her backyard in a nature like environment. LPA observed care of seven children supervised by the licensee. Also present in the home is Licensee's spouse in adult daughter.

Off limit areas consist of Licensee's daughter's bedrooms, detached garage and shed in the backyard. Licensee understands that children may not have access to the off limit areas of the home.

LPA observed a working phone, 2A10BC fire extinguisher, first aid kit and functioning smoke and carbon monoxide detectors. Per licensee, there are no weapons in the home. No children were observed in parked cars. There are no accessible bodies of water on the premises. LPA observed a blow up pool located in the backyard, Licensee was reminded to dump the water after each use and not have any standing water in any containers that have the ability to collect water. Toxic and hazardous items are inaccessible to children. Safe toys were observed. There is no fireplace in the home.

A sample of staff and children's records were reviewed. LPA observed required postings located in the area where parents enter the backyard. Licensee did not have proof of a current children's roster or a current fire drill log. LPA observed recommended COVID19 posters and current guidelines were discussed. Current EMSA Certified pediatric CPR and first aid certification was verified and expires: 07/2022.
Licensee's Mandated Reporter Certification expires 04/30/2022. LPA explained that the OCAP modules are free of cost and available at:http://www.mandatedreporterca.com/ and the training must be renewed every two years.

Continued on LIC809C
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2021
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: MITCHELL, LISA
FACILITY NUMBER: 343623540
VISIT DATE: 07/27/2021
NARRATIVE
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Licensee does not currently provide Incidental Medical Services (IMS). For IMS information, licensee was advised to 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.

LPA discussed Safe Sleep in Child Care. LPA discussed the requirement of having an individual sleeping plan for infants under 12 months and the requirement of maintaining a log of naps for infants who are under two years old.

LPA provided the following link:http://www.cdss.ca.gov/inforesources/Community-Care-Licensing/subscribe for the Licensee to subscribe to the distribution list and receive Quarterly Updates.

This facility evaluation report was reviewed and discussed with the licensee. A notice of site visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of 3 years for public review upon request.

Two Type B deficiencies are cited on the following LIC809D. Appeal Rights provided.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/27/2021 10:59 AM - It Cannot Be Edited


Created By: Tanya Washington On 07/27/2021 at 10:35 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: MITCHELL, LISA
FACILITY NUMBER: 343623540

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2021
Section Cited
CCR
102417(9)(A)

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Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced: Licensee stated that she was unable to locate her log during the inspection.
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Licensee will conduct a fire drill with children, record it on the provided log and send verification to LPA via text or e-mail.

tanya.washington@dss.ca.gov
Type B
08/09/2021
Section Cited
CCR
102417(8)

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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: Licensee could not locate the children's roster during the inspection.
This is a potential risk to the health and safety of children in care.
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Licensee will provide a copy of her children's roster to LPA by POC date of 08/09/2021.

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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:Roxana Saravia
LICENSING EVALUATOR NAME:Tanya Washington
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2021


LIC809 (FAS) - (06/04)
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