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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621670
Report Date: 06/14/2023
Date Signed: 06/14/2023 02:52:31 PM


Document Has Been Signed on 06/14/2023 02:52 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:KAUR, PARMJITFACILITY NUMBER:
393621670
ADMINISTRATOR:KAUR, PARMJITFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 914-2980
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:14CENSUS: 14DATE:
06/14/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:38 PM
MET WITH:Parmjit KaurTIME COMPLETED:
03:15 PM
NARRATIVE
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On June 14, 2023 Licensing Program Analyst (LPA) Stacey Williams conducted a case management inspection at the home of Licensee, Parmjit Kaur. LPA observed (14) fourteen children supervised by Licensee and two adults whom Licensee identified as her Assistants.

Licensee acknowledged that staff #1 (S1) was recently hired as an Assistant and has not been live scanned for criminal record clearance. Licensee stated today is the Assistant's first day working in the facility. LPA discussed regulations pertaining to staff requirements with Licensee.

Based on today's observations, Title 22 Deficiencies have been cited on the attached LIC 8099D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's files.

Exit interview conducted at which time the report was reviewed with Licensee, Parmjit Kaur. A Notice of Site Visit was posted by LPAs William and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023
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 2


Document Has Been Signed on 06/14/2023 02:52 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: KAUR, PARMJIT
FACILITY NUMBER: 393621670

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/15/2023
Section Cited
CCR
1012370(d)(1)

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Criminal Record Clearance. All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption as required by the Department.
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Licensee stated that she will have S1 complete the live scan process for criminal record clearance. Assistant will no longer work in the facility until criminal record clearance is established as well as mandated reporter training and immunization records is on file. Licensee will submit live scan documents
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This requirement was not met as by evidence: LPA was informed by the Licensee that today, 6/14/23 is the first day S1 has worked in the facility. There is no criminal record clearance on file. This is a immediate risk to the health and safety of children in care.
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to LPA by POC- 6/15/23.

Civil Penalties assessed.

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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: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023
LIC809 (FAS) - (06/04)
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