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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500740
Report Date: 09/12/2024
Date Signed: 09/12/2024 12:08:00 PM

Document Has Been Signed on 09/12/2024 12:08 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CANNON, ASIAFACILITY NUMBER:
394500740
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
09/12/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Asia CannonTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
NARRATIVE
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On 09/12/24, Licensing Program Analyst conducted a Case Management inspection and a Plan of Correction visit to clear deficiencies cited on 07/31/24. LPA met with Licensee, Asia Cannon. Present in the facility was Licensee and her assistant caring for 6 daycare children.
LPA inspected the areas accessible to children. Upon arrival LPA observed children present in the backyard which is off limits to the daycare children. LPA observed dog feces in the backyard. Backyard was made off limits because backyard fence needed to be in good repair before children can use the backyard. LPA also discussed with Licensee on today's visit that due to the property line proximity to a neighborhood pond, fencing in the backyard must follow Title 22 Regulations. LPA provided Bodies of Water Evaluation fencing requirement to Licensee on today's visit. During the inspection landscaping crew arrived to work on cutting some of the trees located in the backyard of the home that are preventing from installing a 5 feet fence.
LPA observed that facility have installed child safety strap locks in some cabinets in the bathroom. LPA advised Licensee to make sure strap locks are in good repair and no hazardous items are accessible to the children in the bathroom. LPA observed proof that staff have taken the Mandated Report Training and waiting for certificates to be issue. LPA advised licensee to submit proof of certificates to LPA.

Please refer to attached LIC 809D for deficiencies cited on this date. Exit interview conducted. This report and Appeal of Rights were reviewed and provided to Licensee, Asia Cannon. Notice of Site Visit Posted.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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 09/12/2024 12:08 PM - It Cannot Be Edited


Created By: Elvira Sierra On 09/12/2024 at 11:14 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: CANNON, ASIA
FACILITY NUMBER: 394500740

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2024
Section Cited
CCR
102417(b)

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102417 Operation of a Family Child Care Home. (b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. This requirement was not met as evidence by; LPA observed dog feces in the backyard accessible to the children. This is a deficiency that if not corrected can pose a risk to the health and safety to the children in care.

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POC; Licensee stated that children won't be using the backyard, and will removed the dog feces. LPA will conduct a second visit to verify correction.
Type B
09/30/2024
Section Cited
CCR
102417(g)

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102417 Operation of a Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child. This requirements was not met as evidence by; LPA observed the fence has large broken pieces of wood. This is a requirements that if not corrected can pose a risk to the health and safety of the children in care.

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POC; Licensee is hiring a contractor to repair the fence height is constructed at least 5 feet minimum. Licensee was advised to follow fencing requirements for bodies of water.LPA will conduct a second inspection to verify correction.

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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 Engelman
LICENSING EVALUATOR NAME:Elvira Sierra
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2024


LIC809 (FAS) - (06/04)
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