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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455407911
Report Date: 10/11/2021
Date Signed: 10/12/2021 09:29:36 AM

Document Has Been Signed on 10/12/2021 09:29 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:PORTER, KELSEY FAMILY CHILD CARE HOMEFACILITY NUMBER:
455407911
ADMINISTRATOR:PORTER, KELSEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 921-3365
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
10/11/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Kelsey PorterTIME COMPLETED:
10:48 AM
NARRATIVE
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A visit was conducted in response to an unusual incident that was self-reported in a timely manner by Kelsey Porter, the licensee. The incident occurred on 9/27/21 at about 2:30pm. Community Care Licensing Division (CCLD) was notified within 24 hours and unusual incident report was sent in writing within the 7 days as required. Licensee reported that a child (C1) had gone through the front door and walked away from the home.

LPA Mendez conducted interviews with staff and parent and it was corroborated that (C1) was not under the supervision during the incident. Staff #1 (S1) was near the living room, changing a child in the changing area and children were napping in the daycare room which is away from the living room. (S1) stated that (C1) was supposed to be napping in the living room because (C1) was not feeling well and was separated from the other children. (S1) had received a knock on the door and the neighbors had brought (C1) over, (C1) was found walking on the side of street, two houses down from the daycare home. (S1) received (C1) from neighbors and (C1) can be heard crying on the video of the doorbell alarm that was provided by licensee. Police were called during the incident and a police log was provided. LPA Mendez interviewed parent (P1), (P1) stated that they were informed that their child (C1) had escaped through the front door and were called by licensee, (P1) stated they received a copy of the unusual incident report and a copy of the police log. Licensee stated they were not at the home of the time during the incident. Licensee and S1 stated that child was gone for an estimated time of 5 minutes.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: PORTER, KELSEY FAMILY CHILD CARE HOME
FACILITY NUMBER: 455407911
VISIT DATE: 10/11/2021
NARRATIVE
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Absence of supervision resulting in a child wandering away from the childcare. The following violation of the California Code of Regulations, Tittle 22: Division 12 was observed: see LIC 809D. Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled should sign LIC 9227 form and to parents/guardians of children newly enrolled at the facility during the next 12 months. Notice of Site Visit shall be posted for 30 days from today’s visit.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/12/2021 09:29 AM - It Cannot Be Edited


Created By: Bianca Mendez On 10/11/2021 at 10:26 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: PORTER, KELSEY FAMILY CHILD CARE HOME
FACILITY NUMBER: 455407911

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/11/2021
Section Cited
HSC
1596.99(c)(3)

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Absence of Supervision 1596.99(c)(3) The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation, for any of the following serious violations: Absence of supervision, including, but not limited to, a child left unattended, and supervision of a child by a person under 18 years of age.

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The Licensee agrees to send in a written plan to include how the front door will be secured and children will be supervised Include acknowledgement that LIC9224 will be in each file. Plan to be received by 5pm 10/11/21
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This requirement was not met as evidenced by interviews the child was unsupervised on 9/27/21.
An immediate civil penalty of $500 applies. This poses an immediate health and safety risk to children in care.
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Recommended resource for Active Supervision training: https://eclkc.ohs.acf.hhs.gov/safety-practices/article/keep-children-safe-using-active-supervision

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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:Megan Aviles
LICENSING EVALUATOR NAME:Bianca Mendez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2021


LIC809 (FAS) - (06/04)
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