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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624315
Report Date: 08/11/2023
Date Signed: 08/11/2023 11:33:29 AM

Document Has Been Signed on 08/11/2023 11:33 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HARRIS, MONIQUEFACILITY NUMBER:
343624315
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
08/11/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Vence Lewis and Tuesday RobinsonTIME COMPLETED:
11:45 AM
NARRATIVE
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On Friday, August 11, 2023 at 10:00 AM, Licensing Program Analysts (LPAs) Dao Pa Vang and Tanya Washington met with Staff #1,Vence Lewis for an unannounced case management inspection. Upon arrival, LPAs observed Staff #1 providing care and supervision to one infant and three preschool aged children. Staff #1 informed LPAs that Staff #2, Tuesday Robinson was upstairs. Also present in the home are Licensee's two minor children who were upstairs.

On August 1, 2023, Licensing staff learned that Licensee, Monique Harris has another job and works outside of the home during daycare hours. LPAs also learned that Staff #2 is the main care giver. Licensing Staff were unable to get in touch with the Licensee during today's inspection.

Title 22 Regulation 102417(a) states the following:
The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

Upon arrival at 10:00 AM, Licensing Staff observed Child #1 awake in the playyard. At 11:20 AM Licensing Staff explained to staff that children should not be left in the playyards for extended periods of time and playyards should be utilized for napping purposes only. Staff #2 removed Child #1 from the playyard at 11:20 AM.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/ guardians of children who are currently enrolled as well as parents/ guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must acknowledge receipt of this report and citation by signing a LIC 9224, “ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS”. A copy of this form should be placed in each child file upon receipt from parent.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2023
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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Document Has Been Signed on 08/11/2023 11:33 AM - It Cannot Be Edited


Created By: Dao Vang On 08/11/2023 at 10:48 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HARRIS, MONIQUE
FACILITY NUMBER: 343624315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/14/2023
Section Cited
CCR
102417(a)

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The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute
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Licensee to submit a written plan of correction LPA Vang by POC date of 08/14/2023.

padao.vang@dss.ca.gov
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adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. This requirement is not met as evidenced: Licensing Staff learned that Licensee Harris has a full time job during day-care hours and has assistants providing care to children during her absence. This is an immediate risk to the health and safety of children in care.
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Type A
08/14/2023
Section Cited
CCR102423(a)2

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Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:
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Licensee will submit a written plan of correction to LPA Vang by POC date of 08/14/2023.

padao.vang@dss.ca.gov
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To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
This requirement is not met as evidenced: At 10:00 AM, Licensing staff observed Child #1 awake in a playyard. Licensing staff explained to Staff #2 that children cannot be left in playyards for extended periods of time. Child #1 was removed from the playyard at 11:20 AM.
This is an immediate risk to the health and safety of children care.
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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:Seychelle De Luca
LICENSING EVALUATOR NAME:Dao Vang
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2023


LIC809 (FAS) - (06/04)
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