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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416737
Report Date: 02/28/2023
Date Signed: 02/28/2023 01:59:51 PM

Document Has Been Signed on 02/28/2023 01:59 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ROSIER, RACELFACILITY NUMBER:
434416737
ADMINISTRATOR:RACEL ROSIERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 208-9722
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 9DATE:
02/28/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Racel Rosier & Randy RosierTIME COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Marilou Monico and Ashley Lopez, conducted an unannounced case management inspection. LPAs met with Licensee, Racel Rosier, and her husband, Randy Rosier. LPAs learned from interviews that on February 7, 2023, a day-care child wandered outside of the facility and found by a parent who was picking up a child. Licensee failed to report the incident to Licensing.

Deficiency was cited on the following page:

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2023
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 02/28/2023 01:59 PM - It Cannot Be Edited


Created By: Marilou Monico On 02/28/2023 at 01:01 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ROSIER, RACEL
FACILITY NUMBER: 434416737

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/03/2023
Section Cited
CCR
102416.2(b)(2)

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Reporting Requirements - The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home.(2) Any child absence means any instance where a child in care is missing.
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Licensee agreed to submit a completed Unusual Incident/Injury Report (LIC 624B) and a written plan by 03/03/23 detailing how she will ensure that any unusual incidents shall be reported to Licensing within the required time frame.
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This requirement is not met as evidenced by:
LPAs learned from interviews that an incident occurred on 02/07/23 in which a child wandered outside of the facility was not reported to Licensing. This poses a potential risk to the health, safety, and personal rights of children in care.
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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:Joel Segura
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2023


LIC809 (FAS) - (06/04)
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