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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216000
Report Date: 08/20/2021
Date Signed: 09/15/2021 11:30:23 AM

Document Has Been Signed on 09/15/2021 11:30 AM - 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:RUSSELL FCC AKA PITTER PATTER FCCFACILITY NUMBER:
406216000
ADMINISTRATOR:BRITTANY RUSSELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 235-1567
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
08/20/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:23 AM
MET WITH:Brittany RusselTIME COMPLETED:
11:30 AM
NARRATIVE
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On 8/20/21 at 9:23am, Licensing Program Analyst (LPA) Melissa Stewart conducted an unannounced POC inspection and met with Staff #1 (S1) at the entrance of the Family Child Care Home (FCCH). LPA explained that the purpose of the visit was to follow up regarding the staff person who had been providing care and supervision without a criminal record clearance associated with the facility. LPA conducted a Risk Assessment for COVID19 and all answers indicated no exposure to COVID19 within the past 14 days. S1 and Elizabeth Gonzalez were supervising seven (7) children who were eating snack at the table in the indoor activity area. Neither S1 or Elizabeth Gonzalez were wearing face coverings. S1 reported that Licensee, Brittany Russell, was not at the home at this time. LPA informed S1 and Elizabeth Gonzalez that they (and children over the age of 2 years) are required to wear face coverings while indoors as previously discussed with Licensee on 6/25/2021. LPA observed both S1 and Elizabeth Gonzalez put on face coverings. Staff helped children over the age of 2 years put on face coverings after they finished eating.

Elizabeth Gonzalez reported that fingerprints were submitted via LIVE SCAN on 6/25/21. LPA reviewed original LIVE SCAN form provided by Elizabeth Gonzalez which was submitted with an incomplete facility number. Documents were submitted to correctly associate the employee to the FCCH.

A copy of this report and appeal rights were discussed and left with Licensee, Brittany Russell, whose signature on this form confirm receipt of these documents.

LPA observed Licensee post the Notice of Site visit which must remain posted for 30 days.

This report was AMENDED to remove the deficiency previously cited. Amended report approved by Licensing Program Manager (LPM) Maria Mueller on 9/14/2021.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Melissa K Stewart
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2021
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 09/15/2021 11:34 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 09/14/2021 05:50 PM


Created By: Melissa K Stewart On 08/20/2021 at 10:13 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: RUSSELL FCC AKA PITTER PATTER FCC
FACILITY NUMBER: 406216000

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/20/2021
Section Cited
CCR
102370(d)

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Elizabeth Gonzalez reported that fingerprints were submitted via LIVE SCAN on 6/25/21. Original LIVE SCAN form was submitted with an incomplete facility number. Documents were submitted to associate the employee to the FCCH.
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This report was AMENDED to remove the Type A deficiency previously cited.

Amended report approved by Licensing Program Manager (LPM) Maria Mueller on 9/14/2021.
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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:Maria Mueller
LICENSING EVALUATOR NAME:Melissa K Stewart
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2021


LIC809 (FAS) - (06/04)
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