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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455407933
Report Date: 02/02/2024
Date Signed: 02/02/2024 04:01:15 PM

Document Has Been Signed on 02/02/2024 04:01 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:MANN, KIM FAMILY CHILD CARE HOMEFACILITY NUMBER:
455407933
ADMINISTRATOR:MANN, KIMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 228-4679
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 3DATE:
02/02/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Kim Mann, LicenseeTIME COMPLETED:
04:30 PM
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On 2/2/24, Licensing Program Analyst (LPA) E. Friese and N. Cunningham conducted a case management inspection. During today's inspection LPAs observed an infant (Child 2) sleeping in a bedroom with the door closed. The licensee stated she was aware of the requirement to log sleep checks but has not documented sleep checks recently. The licensee stated her assistant provided care on two different dates for approximately 1 hour while the licensee attended an appointment.


The following deficiencies were cited: infant sleeping in a bedroom with door closed, licensee did not document sleep checks, and assistant provided care without a fingerprint clearance. See LIC809D.

Appeal Rights (LIC 9058) were provided. Reports citing Type A violations, an immediate Health and Safety risk to children in care, are to be provided to parents/guardians of children currently in care of the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians will be required to sign Acknowledgement of Receipt of Licensing Reports (LIC 9224).

Notice of Site Visit shall be posted for 30 days from today's inspection.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2024
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 02/02/2024 04:01 PM - It Cannot Be Edited


Created By: Nicolette Cunningham On 02/02/2024 at 03:38 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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: MANN, KIM FAMILY CHILD CARE HOME
FACILITY NUMBER: 455407933

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/03/2024
Section Cited
CCR
102370(d)(1)

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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or
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The licensee stated she will see that her assistant obtains a fingerprint clearance before she cares for children. The licensee stated she will submit proof that her assistant obtained a fingerprint clearance to CCL by 2/9/24.
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This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above in one employee did not have a fingerprint clearance when providing care for children which poses an immediate health, safety or personal rights risk to persons 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:Erin Virrueta
LICENSING EVALUATOR NAME:Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 02/02/2024 04:01 PM - It Cannot Be Edited


Created By: Nicolette Cunningham On 02/02/2024 at 03:50 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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: MANN, KIM FAMILY CHILD CARE HOME
FACILITY NUMBER: 455407933

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2024
Section Cited
CCR
102425(j)(1)

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(j) The provider shall supervise infants while they are sleeping and adhere to the following requirements:

(1) The provider shall physically check on the infant every 15 minutes.
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The licensee stated she will resume completing sleep checks and log all checks. The licensee stated she will complete sleep checks and logs and send copies to LPA by 2/9/24.

nicolette.cunningham@dss.ca.gov
Type B
02/09/2024
Section Cited
CCR
102425(j)(5)(a)

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INFANT SAFE SLEEP (A) The provider shall be able to visually observe infants without moving the door.

This requirement was not met as evidenced by: interviews revealed that the licensee sleeps infants in a bedroom with the door closed.
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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: 02/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2024


LIC809 (FAS) - (06/04)
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