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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621661
Report Date: 09/15/2022
Date Signed: 09/15/2022 02:58:14 PM

Document Has Been Signed on 09/15/2022 02:58 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:TINY TOTS ACADEMYFACILITY NUMBER:
393621661
ADMINISTRATOR:KETTGEN, CANDIFACILITY TYPE:
830
ADDRESS:250 NORTHGATE DRIVETELEPHONE:
(209) 294-9803
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 6DATE:
09/15/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Candi KettgenTIME COMPLETED:
03:00 PM
NARRATIVE
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On 09/15/2022, Licensing Program Analysts Katy Maestas (LPA1) and Mariya Melnichuk (LPA2) conducted a field visit to the Center for the purpose of a case management inspection. LPAs arrived at the Center and were met by Director Candi Kettgen (D1). LPA1 disclosed the purpose of the inspection and was granted entrance into the Center by D1. LPAs toured the Center and observed 6 children under the age of 2 years being supervised by 2 adults. LPA1 determined through accessing Guardian that all required adults are background cleared. LPA requested a copy of the Facility Roster.

LPAs observed 2 cribs being utilized for sleeping babies that had blankets inside the cribs. An adult teacher immediately removed the blankets upon LPAs entering the classroom. LPA1 discussed the importance of Safe Sleep Regulations with D1. LPA1 provided D1 with: Safe Sleep Concepts and Regulations, Safe Sleep brochure, Safe Sleep poster, A Child Care Provider's Guide to Safe Sleep, and PIN19-02-CCP for distribution to Staff Members.

As a result of blankets inside 2 cribs, 1 deficiency was cited on subsequent 809-D page. An exit interview was conducted, and the report was reviewed with D1. Licensee Appeal Rights were provided to D1. A Notice of Site Visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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 09/15/2022 02:58 PM - It Cannot Be Edited


Created By: Nola Maestas On 09/15/2022 at 01:35 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: TINY TOTS ACADEMY
FACILITY NUMBER: 393621661

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/14/2022
Section Cited
CCR
101439.1(f)

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(a) In addition to Section 101239.1, the following shall apply.... (f) Cribs shall be free from all loose articles and objects, including blankets and pillows.

This requirement was not meet as evidenced by:
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D1 stated that blankets have been removed from the cribs. In addition, a Staff Meeting will be held to discuss Safe Sleep Practices and Safe Sleep documents will be distributed to staff members.
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 LPA1 Maestas and LPA 2 Melnichuk observed blankets inside 2 cribs with sleeping infants. This poses and immediate health and safety risk to children in care.
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D1 will provide LPA with Staff Mtg agenda, signatures of all staff in attendance and that staff received documents.

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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:Jeanne Smith
LICENSING EVALUATOR NAME:Nola Maestas
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2022


LIC809 (FAS) - (06/04)
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