394500840-5-2-2023-53-CC-CPRA-CRFSUL-20230502141121

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500840
Report Date: 05/02/2023
Date Signed: 05/02/2023 02:11:31 PM

Document Has Been Signed on 05/02/2023 02:11 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	TATUM-HENDERSON, LATISHA		FACILITY NUMBER:	394500840
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS:	DATE:	05/02/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Applicant Latisha Tatum-Henderson		TIME COMPLETED:	02:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 5/2/23 Licensing Program Analyst (LPA) Carla Polanco conducted a change of location inspection with applicant, Latisha Tatum-Henderson. All individuals subject to criminal background review have obtained a criminal record clearance. A health and safety inspection was conducted inside and out the home. The home has 5 bedrooms, 3 bathrooms, a formal dining room, kitchen, a living room, a downstairs bedroom/play room, a laundry room, garage, fenced backyard, three upstairs bedrooms, upstairs bathroom and upstairs master bedroom and bathroom. The off-limit areas in the home are entire upstairs, garage and laundry room. LPA advised the applicant that if there are ever any poisons at the home, all poisons must be locked with a key lock or combination lock. LPA observed the fireplace to be barricaded in the living room. LPA observed the home to provide safe toys, play equipment and materials for the day care children. LPA observed the stairs to be barricaded. LPA observed a fish pond in the backyard. LPA took photos of the pond. Currently the pond does not meet Title 22 regulations. LPA will discuss the pond with management for further review. Toxic and hazardous items are inaccessible to children. LPA observed functioning smoke and carbon monoxide detectors. LPA did not observed a fire extinguisher in the home that meets Title 22 regulations. A working telephone was observed. Applicant stated there are no weapons in the home. Current EMSA approved pediatric CPR and First Aid training was verified and expires 4/25. Applicant's CA AB1207 Mandated Reporter Training expires 9/24. Applicant is signed up for the 8 hour Preventative Health and Safety Training with the Lead Poisoning Prevention training. Page 1. Report Continues on LIC 809-C...

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: TATUM-HENDERSON, LATISHA	FACILITY NUMBER: 394500840
	VISIT DATE: 05/02/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care 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 Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Records, postings and reporting requirements were discussed. LIC311D was provided and discussed. Applicant was encouraged to visit the department website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes. LPA provided and discussed the Safe Sleep in Child Care Regulations (and provided a copy). LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list. childcareadvocatesprogram@dss.ca.gov.

Applicant was encouraged to always maintain supervision. LPA discussed requirements for staff, adult assistants, and adults living in the home. LPA discussed the new Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care Home must have vaccinations against Pertussis, Measles, and Influenza (Influenza is optional). LPA observed proof of applicant's immunization in the facility file. Type A/B citations and Immediate Civil Penalty regulation deficiencies were reviewed. Applicant understands that a current roster must be maintained and that a fire drill must be conducted and documented once every six months.

Page 2. Report Continues on LIC 809-C...

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: TATUM-HENDERSON, LATISHA	FACILITY NUMBER: 394500840
	VISIT DATE: 05/02/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Applicant understands that anyone living or working in the home, eighteen years of age or older must obtain fingerprint clearance PRIOR to living or working in the home. Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. LPA explained to applicant that if she relocates and wants to continue to provide care, she must submit a change of location application and have the new home inspected.

Applicant understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within 7 days to remain in compliance. Applicant understands that if any structural changes are made to the home; licensing must be notified prior to construction. Applicant understands that if they want to make any off-limit area an ON-limits area, they must notify licensing and LPA must do an inspection BEFORE children are allowed in the area. Applicant understands that children’s records are to be maintained according to Title 22 regulations, and be accessible to licensing for up to three years.

On today's date 5/2/23 the facility was not approved for a small family child care home license. Pending items are:
-in-ground fish pond shall be inaccessible to children and shall meet Title 22 regulations
-fire extinguisher shall meet Title 22 regulations

Tittle 22 regulations for bodies of water was provided to Licensee.

Applicant will be in communication with Department about the above items. Once the above items are reviewed by management, meet Title 22 regulations, and are approved by the Department, the home can be licensed as a Small Family Child Care Home license for a capacity of 8 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.

An exit interview was conducted. Appeal Rights were provided.

Page 3

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3