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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
376623091
Report Date:
07/22/2022
Date Signed:
07/22/2022 04:15:59 PM
Document Has Been Signed on
07/22/2022 04:15 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
CCLD Regional Office
,
7575 METROPOLITAN DR STE 110
SAN DIEGO
,
CA
92108
FACILITY NAME:
SCHAFFER, FLORA FAMILY CHILD CARE
FACILITY NUMBER:
376623091
ADMINISTRATOR:
FLORA SCHAFFER
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(858) 539-6041
CITY:
SAN DIEGO
STATE:
CA
ZIP CODE:
92122
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
10
DATE:
07/22/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
11:38 AM
MET WITH:
Flora Schaffer
TIME COMPLETED:
04:45 PM
NARRATIVE
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On 7/22/22 at 11:38am Licensing Program Analyst (LPA) Patrick Ma conducted an unannounced annual inspection with the Licensee. Upon arrival, LPA met with Licensee Flora Shaffer. Also, in the home was helper/husband Carlos Gomez-Resendiz. Licensee was provided the Inspection Checklist (LIC 126). The one story home was toured and inspected to ensure an environment safe for the care and supervision of children. Present in the home were 13 day care children, 4 of the children were infants.
Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include the living room, dining room, kitchen, 1 bedroom (used for napping only), and 1 bathroom. Off limits areas include 2 back bedrooms, garage, and small courtyard and are inaccessible through use of door knob covers, gate, and sliding door lock. The licensee has sufficient toys and equipment available. The home has a fenced backyard available for outdoor activities. Licensee understands that supervision is required at all times during outdoor activities. LPA conducted child care quality management interview with the Licensee.
The fire extinguisher, smoke detector, and carbon monoxide detector meet requirements and are operational. All hazardous items were latched/locked and secured during the inspection. There is no body of water on the property. Licensee states that there are no weapons in the home. First Aid and CPR certifications expired on 3/2021. Licensee has required immunizations. Licensee was advised that Mandated Reporter Training must be completed every 2 years. Children’s and Staff records were reviewed.
SUPERVISORS NAME
:
Renesha Askew
LICENSING EVALUATOR NAME
:
Patrick Ma
LICENSING EVALUATOR SIGNATURE
:
DATE:
07/22/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
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Document Has Been Signed on
07/22/2022 04:15 PM
- It Cannot Be Edited
Created By:
Patrick Ma
On
07/22/2022
at
02:39 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
,
7575 METROPOLITAN DR STE 110
SAN DIEGO
,
CA
92108
FACILITY NAME:
SCHAFFER, FLORA FAMILY CHILD CARE
FACILITY NUMBER:
376623091
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/22/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, cleaning solutions were found under the kitchen and bathroom sink cabinets, which poses an immediate health and safety risk to children in care.
POC Due Date:
07/22/2022
Plan of Correction
1
2
3
4
Licensee made all hazardous items and materials inaccessible during the inspection.
Type A
Section Cited
CCR
102416.3(a)(1)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (1) Conversion of a garage (either attached or detached) into a "child care" room.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, infant was found sleeping in the garage on a bouncy chair which is identified as an off-limit area which has not been converted into a livable living space. The garage is used as a storage area with heavy equipment and medicine accessible which poses an immediate health and safety risk to children in care.
POC Due Date:
07/22/2022
Plan of Correction
1
2
3
4
Licensee removed the infant from the garage and placed a gate at the doorway to make it inaccessible during the inspection and stated she will no longer use the garage.
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:
Renesha Askew
LICENSING EVALUATOR NAME:
Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE:
07/22/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/22/2022
LIC809
(FAS) - (06/04)
Page:
2
of
15
Document Has Been Signed on
07/22/2022 04:15 PM
- It Cannot Be Edited
Created By:
Patrick Ma
On
07/22/2022
at
02:39 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
,
7575 METROPOLITAN DR STE 110
SAN DIEGO
,
CA
92108
FACILITY NAME:
SCHAFFER, FLORA FAMILY CHILD CARE
FACILITY NUMBER:
376623091
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/22/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(d)(1)
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: (1) Twelve children, no more than four of whom may be infants; or
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation Licensee was caring for 9 preschool children and 4 infants at one time for a total capacity of 13 children. This poses an immediate health and safety risk to children in care.
POC Due Date:
07/25/2022
Plan of Correction
1
2
3
4
Licensee stated she will provide an active children's roster by 7/25/22 of children enrolled that meets capacity regulations to LPA Ma via email (patrick.ma@dss.ca.gov).
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:
Renesha Askew
LICENSING EVALUATOR NAME:
Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE:
07/22/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/22/2022
LIC809
(FAS) - (06/04)
Page:
3
of
15
Document Has Been Signed on
07/22/2022 04:15 PM
- It Cannot Be Edited
Created By:
Patrick Ma
On
07/22/2022
at
02:39 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
,
7575 METROPOLITAN DR STE 110
SAN DIEGO
,
CA
92108
FACILITY NAME:
SCHAFFER, FLORA FAMILY CHILD CARE
FACILITY NUMBER:
376623091
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/22/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, Fire/Disaster drill log posted on the wall indicated the last drill completed was 11/16/15, which poses a potential health and safety risk to children in care.
POC Due Date:
08/22/2022
Plan of Correction
1
2
3
4
Licensee stated she will complete and provide proof of completed emergency drill by 8/22/22 to LPA Ma via email (patrick.ma@dss.ca.gov).
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:
Renesha Askew
LICENSING EVALUATOR NAME:
Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE:
07/22/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/22/2022
LIC809
(FAS) - (06/04)
Page:
4
of
15
Document Has Been Signed on
07/22/2022 04:15 PM
- It Cannot Be Edited
Created By:
Patrick Ma
On
07/22/2022
at
02:39 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
,
7575 METROPOLITAN DR STE 110
SAN DIEGO
,
CA
92108
FACILITY NAME:
SCHAFFER, FLORA FAMILY CHILD CARE
FACILITY NUMBER:
376623091
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/22/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(10)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, infant was found in a bouncer during the inspection, which poses a potential health and safety risk to infant in care.
POC Due Date:
07/25/2022
Plan of Correction
1
2
3
4
Licensee removed baby bouncer and place in a off-limited room during inspection and stated she will not allow any prohibited iteams to be used in her facility again.
Type B
Section Cited
CCR
102425(a)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, 3 of 4 infants were placed in bassinets for sleeping purposes, which poses a potential health and safety risk to the infants in care.
POC Due Date:
07/25/2022
Plan of Correction
1
2
3
4
Licensee removed the children from their bassinets and placed them in play yards for the remainder of their nap during the inspection. Licensee stated she will only used cribs and play yards for infant sleep according to regulations from now on.
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:
Renesha Askew
LICENSING EVALUATOR NAME:
Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE:
07/22/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/22/2022
LIC809
(FAS) - (06/04)
Page:
5
of
15
Document Has Been Signed on
07/22/2022 04:15 PM
- It Cannot Be Edited
Created By:
Patrick Ma
On
07/22/2022
at
02:39 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
,
7575 METROPOLITAN DR STE 110
SAN DIEGO
,
CA
92108
FACILITY NAME:
SCHAFFER, FLORA FAMILY CHILD CARE
FACILITY NUMBER:
376623091
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/22/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
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, 3 of 4 infants were found with blankets, stuffed toy, and bottle, which poses a potential health and safety risk to infant in care.
POC Due Date:
07/25/2022
Plan of Correction
1
2
3
4
Licensee removed the blankts, stuffed toys, and bottles from the infant sleep areas during inspection and stated she will not have any items except a pacifier while infants sleep.
Type B
Section Cited
CCR
102425(j)(5)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observations, 3 of 4 children were found sleeping in rooms with the door closed, which poses a potential health and safety risk to children in care.
POC Due Date:
07/25/2022
Plan of Correction
1
2
3
4
Licensee opended the doors to the infant sleep areas during the inspection and stated she will keep doors open in rooms where infants sleep from now on.
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:
Renesha Askew
LICENSING EVALUATOR NAME:
Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE:
07/22/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/22/2022
LIC809
(FAS) - (06/04)
Page:
6
of
15
Document Has Been Signed on
07/22/2022 04:15 PM
- It Cannot Be Edited
Created By:
Patrick Ma
On
07/22/2022
at
02:39 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
,
7575 METROPOLITAN DR STE 110
SAN DIEGO
,
CA
92108
FACILITY NAME:
SCHAFFER, FLORA FAMILY CHILD CARE
FACILITY NUMBER:
376623091
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/22/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on records review and interview, Licensee and husband/helper did not have Mandated Reporter Certificates and Licensee stated that she was unaware of the requirements, which poses a potential health and safety risk to children in care.
POC Due Date:
08/22/2022
Plan of Correction
1
2
3
4
Licensee stated she will complete the Mandated Reporter training (www.mandatedreporterca.com) and have all her helpers complete the training and submit proof to LPA Ma via email by 8/22/22.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on records review, immunization records were not on file for the husband/helper or any helpers, which poses a potential health and safety risk to children in care.
POC Due Date:
08/22/2022
Plan of Correction
1
2
3
4
Licensee stated she will have all helper immunizations on file and submit proof to LPA Ma by 8/22/22.
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:
Renesha Askew
LICENSING EVALUATOR NAME:
Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE:
07/22/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/22/2022
LIC809
(FAS) - (06/04)
Page:
7
of
15
Document Has Been Signed on
07/22/2022 04:15 PM
- It Cannot Be Edited
Created By:
Patrick Ma
On
07/22/2022
at
02:39 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
,
7575 METROPOLITAN DR STE 110
SAN DIEGO
,
CA
92108
FACILITY NAME:
SCHAFFER, FLORA FAMILY CHILD CARE
FACILITY NUMBER:
376623091
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/22/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on records review, Licensee's First Aid/CPR certificate expired on 3/2021, which poses a potential health and safety risk to children in care.
POC Due Date:
08/22/2022
Plan of Correction
1
2
3
4
Licensee stated that will enroll in a pediatric EMSA First Aid/CPR class and submit proof of enrollment to LPA Ma by 8/22/22.
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on records review, 14 of the 14 children did not have their immunizations on record, which poses a potential health and safety risk to children in care.
POC Due Date:
08/22/2022
Plan of Correction
1
2
3
4
LIcensee stated she will request, documents, and submit proof to LPA Ma that all children enrolled have their immunization records on file in the facility.
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:
Renesha Askew
LICENSING EVALUATOR NAME:
Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE:
07/22/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/22/2022
LIC809
(FAS) - (06/04)
Page:
8
of
15
Document Has Been Signed on
07/22/2022 04:15 PM
- It Cannot Be Edited
Created By:
Patrick Ma
On
07/22/2022
at
02:39 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
,
7575 METROPOLITAN DR STE 110
SAN DIEGO
,
CA
92108
FACILITY NAME:
SCHAFFER, FLORA FAMILY CHILD CARE
FACILITY NUMBER:
376623091
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/22/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
1
2
3
4
Based on records review, Licensee did not have an updated child care roster on file, which poses a potential health and safety risk to children in care.
POC Due Date:
08/22/2022
Plan of Correction
1
2
3
4
LIcensee stated she will complete and submit proof of an updated child care roster to LPA Ma by 8/22/22.
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:
Renesha Askew
LICENSING EVALUATOR NAME:
Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE:
07/22/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/22/2022
LIC809
(FAS) - (06/04)
Page:
9
of
15
Document Has Been Signed on
07/22/2022 04:15 PM
- It Cannot Be Edited
Created By:
Patrick Ma
On
07/22/2022
at
02:39 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
,
7575 METROPOLITAN DR STE 110
SAN DIEGO
,
CA
92108
FACILITY NAME:
SCHAFFER, FLORA FAMILY CHILD CARE
FACILITY NUMBER:
376623091
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/22/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on records review, 14 of the 14 children did not have completed enrolment forms on file (LIC 282, LIC 627, LIC 700, LIC 995A, LIC 9150), which poses a potential health and safety risk to children in care, which poses a potential health and safety risk to children in care.
POC Due Date:
08/22/2022
Plan of Correction
1
2
3
4
Licensee stated she will submit proof of completed child enrollment documents for all children enrolled to LPA Ma by 8/22/22.
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:
Renesha Askew
LICENSING EVALUATOR NAME:
Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE:
07/22/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/22/2022
LIC809
(FAS) - (06/04)
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Document Has Been Signed on
07/22/2022 04:15 PM
- It Cannot Be Edited
Created By:
Patrick Ma
On
07/22/2022
at
02:39 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
,
7575 METROPOLITAN DR STE 110
SAN DIEGO
,
CA
92108
FACILITY NAME:
SCHAFFER, FLORA FAMILY CHILD CARE
FACILITY NUMBER:
376623091
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/22/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.
This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on records review, 1 of 1 infant (under 1 yr) did not have an Infant Sleep Plan on file, which poses a potential health and safety risk to the infant in care.
POC Due Date:
08/22/2022
Plan of Correction
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4
LIcensee stated she will submit a completed Infant Sleep plan for child #1 by 8/22/22 and begin to have all enrolling children under 12 months complete the documents before their first day of care.
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review and interview, Licensee states she was unaware of the requirements to documents infant sleeps checks every 15-mins and has no records of them, which poses a potential health and safety risk to children in care.
POC Due Date:
08/22/2022
Plan of Correction
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Licensee stated she will submit proof of sleep logs use for all infants to LPA Ma by 8/22/22.
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:
Renesha Askew
LICENSING EVALUATOR NAME:
Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE:
07/22/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/22/2022
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
,
7575 METROPOLITAN DR STE 110
SAN DIEGO
,
CA
92108
FACILITY NAME:
SCHAFFER, FLORA FAMILY CHILD CARE
FACILITY NUMBER:
376623091
VISIT DATE:
07/22/2022
NARRATIVE
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Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA reviewed Covid-19 guidelines with Licensee and provided Covid-19 resources. LPA directed Licensee to website:
https://www.cdss.ca.gov/inforesources/community-care-licensing
to receive important updates and information. LPA and Licensee discussed California Megan's Law and LPA provided:
www.meganslaw.ca.gov
.
LPA discussed the safe sleep regulations with licensee and discussed the Childcare 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 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 reviewed with Licensee the LIC 311D, Forms/Records. To Keep In Your Family Childcare Homes, children’s forms/records, facility forms/records, and information to be posted.
A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions.
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 Childcare 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.
SUPERVISORS NAME
:
Renesha Askew
LICENSING EVALUATOR NAME
:
Patrick Ma
LICENSING EVALUATOR SIGNATURE
:
DATE:
07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/22/2022
LIC809
(FAS) - (06/04)
Page:
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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
,
7575 METROPOLITAN DR STE 110
SAN DIEGO
,
CA
92108
FACILITY NAME:
SCHAFFER, FLORA FAMILY CHILD CARE
FACILITY NUMBER:
376623091
VISIT DATE:
07/22/2022
NARRATIVE
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LPA discussed and provided Licensee with the following: childcare advocates-email address:
childcareadvocatesprogram@dss.ca.gov
. In addition, for general questions or questions regarding licensing requirements contact the Childcare Licensing Duty Line at (619) 767-2248.
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Childcare 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 Childcare Centers and the ADA, available at:
http://www.ada.gov/childqanda.htm
See LIC809D for deficiencies cited.
LPA Patrick Ma informed licensee Flora Shaffer that this report dated 7/22/22 documents 3 Type A citations which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care. Also, LPA Patrick Ma informed the licensee to provide a copy of this licensing report dated 7/22/22 that documents any Type A citations 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.
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
.
Exit interview conducted and report was reviewed with the licensee Flora Shaffer. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME
:
Renesha Askew
LICENSING EVALUATOR NAME
:
Patrick Ma
LICENSING EVALUATOR SIGNATURE
:
DATE:
07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/22/2022
LIC809
(FAS) - (06/04)
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of
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