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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 451375074
Report Date: 03/16/2023
Date Signed: 03/17/2023 08:24:45 AM

Document Has Been Signed on 03/17/2023 08:24 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:DUNCAN, SHERRIE FAMILY DAY CAREFACILITY NUMBER:
451375074
ADMINISTRATOR:DUNCAN, SHERRIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 275-1935
CITY:SHASTA LAKE CITYSTATE: CAZIP CODE:
96019
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
03/16/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Sherrie Duncan, LicenseeTIME COMPLETED:
11:15 AM
NARRATIVE
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On 3/16/23 at 9:15am, Licensing Program Analyst (LPA) N. Cunningham conducted a case management inspection. During the visit, LPA Cunningham observed an infant sleeping in a chair in a play yard with a blanket over the chair. LPA photographed the sleeping arrangement.

The following deficiencies were cited: infant was sleeping in a rocking chair in a play yard and no nap logs were on file. (see LIC 809D):

LPA Cunningham informed licensee to provide a copy of this licensing report dated 03/16/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with Licensee Duncan.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2023
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 03/17/2023 08:24 AM - It Cannot Be Edited


Created By: Nicolette Cunningham On 03/16/2023 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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: DUNCAN, SHERRIE FAMILY DAY CARE
FACILITY NUMBER: 451375074

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/17/2023
Section Cited
CCR
102425(d)

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(d) The provider shall place infants up to 12 month of age on their backs for sleeping.

This requirement is not met as evidenced by: LPA's observation of an infant sleeping in a swing and licensee's statements. This poses an immediate Health and Safety risk to children in care.
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Licensee will go through safe sleep regulations and will ensure that all infants are sleep in a crib or play yard. Licensee will submit in writing that she has read through safe sleep regulations and inform her assistants. Plan of correction is due 3/17/23.
Type A
03/17/2023
Section Cited
CCR
102425(j)(d)

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(j) The provider shall supervise infants while they are sleeping and adhere to the following requirements: Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:
a. Date.
b. Infant’s name.
c. Time of each 15-minute check.
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Licensee will start documenting for every infant every 15 minute check and have documentation available for licensing.
Plan of correction will be submitted by 3/17/23.
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This requirement was not met as evidenced based on LPA Cunningham observation and review. Licensee does not have documentation for 2 infants in care regarding 15 minute check. This poses an immediate Health and Safety risk to children in care.
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Licensee can submit proof of correction to:
nicolette.cunningham@dss.ca.gov
fax: 707-895-5934

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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:Erin Virrueta
LICENSING EVALUATOR NAME:Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023


LIC809 (FAS) - (06/04)
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