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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
475407728
Report Date:
01/03/2024
Date Signed:
01/04/2024 08:09:17 AM
Document Has Been Signed on
01/04/2024 08:09 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:
LAWRENCE-SAMPSON FAMILY CHILD CARE HOME
FACILITY NUMBER:
475407728
ADMINISTRATOR:
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
CITY:
STATE:
ZIP CODE:
CAPACITY:
8
TOTAL ENROLLED CHILDREN:
8
CENSUS:
5
DATE:
01/03/2024
TYPE OF VISIT:
Required - 3 Year
UNANNOUNCED
TIME BEGAN:
01:00 PM
MET WITH:
Ms. Lawrence and Mr. Sampson
TIME COMPLETED:
04:00 PM
NARRATIVE
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On 1/3/2024 at 1:00pm, an annual inspection was made to the facility by Licensing Program Analyst's (LPA) Dutra and Cunningham. At 2:00pm the home was toured inside and outside. The licensee was supervising five children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 7:00am-5:00pm, Monday–Friday. The floor plan submitted by the licensee was reviewed. The off-limits areas of the home are two bedrooms and master bedroom, and were made inaccessible by child gate. The children use the back yard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed in the yard.
Five children's records were reviewed at 1:10pm. Three staff records were reviewed at 1:30pm. There are currently two adults living in the home.
*Continued on 809C
SUPERVISORS NAME
:
Erin Virrueta
LICENSING EVALUATOR NAME
:
Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE
:
DATE:
01/03/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE
,
520 COHASSET RD., SUITE 170
CHICO
,
CA
95926
FACILITY NAME:
LAWRENCE-SAMPSON FAMILY CHILD CARE HOME
FACILITY NUMBER:
475407728
VISIT DATE:
01/03/2024
NARRATIVE
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to
inspectionprocess@dss.ca.gov
. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process
.
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep
as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at
https://www.cpsc.gov/
and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
SUPERVISORS NAME
:
Erin Virrueta
LICENSING EVALUATOR NAME
:
Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE
:
DATE:
01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/03/2024
LIC809
(FAS) - (06/04)
Page:
2
of
8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE
,
520 COHASSET RD., SUITE 170
CHICO
,
CA
95926
FACILITY NAME:
LAWRENCE-SAMPSON FAMILY CHILD CARE HOME
FACILITY NUMBER:
475407728
VISIT DATE:
01/03/2024
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at:
https://www.ada.gov/resources/child-care-centers/
.
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
During the exit interview, the licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee Lawrence.
SUPERVISORS NAME
:
Erin Virrueta
LICENSING EVALUATOR NAME
:
Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE
:
DATE:
01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/03/2024
LIC809
(FAS) - (06/04)
Page:
8
of
8
Document Has Been Signed on
01/04/2024 08:09 AM
- It Cannot Be Edited
Created By:
Nicolette Cunningham
On
01/03/2024
at
02:48 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:
LAWRENCE-SAMPSON FAMILY CHILD CARE HOME
FACILITY NUMBER:
475407728
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
01/03/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in one small heater that was hot to the touch was accessible to children in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
01/04/2024
Plan of Correction
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2
3
4
The licensee moved the small heater to the garage. The licensee stated she will use the main house heater in the future.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
01/03/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/03/2024
LIC809
(FAS) - (06/04)
Page:
3
of
8
Document Has Been Signed on
01/04/2024 08:09 AM
- It Cannot Be Edited
Created By:
Nicolette Cunningham
On
01/03/2024
at
02:48 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:
LAWRENCE-SAMPSON FAMILY CHILD CARE HOME
FACILITY NUMBER:
475407728
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
01/03/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.
This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on interview and file review, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care. Specifically, licensee has never conducted a fire drill in the last 24 months.
POC Due Date:
01/05/2024
Plan of Correction
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Facility to conduct fire drill by the end of the week and submit log to CCL by 1/5/24.
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:
01/03/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/03/2024
LIC809
(FAS) - (06/04)
Page:
4
of
8
Document Has Been Signed on
01/04/2024 08:09 AM
- It Cannot Be Edited
Created By:
Nicolette Cunningham
On
01/03/2024
at
02:48 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:
LAWRENCE-SAMPSON FAMILY CHILD CARE HOME
FACILITY NUMBER:
475407728
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
01/03/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:
This requirement is not met as evidenced by:
Deficient Practice Statement
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2
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4
Based on interview and file review, the licensee did not comply with the section cited above in three out of three files did not contain sleep logs which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
01/10/2024
Plan of Correction
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4
Licensee Lawrence stated she will review safe sleep regulations and send an e-mail to LPA confirming. Licensee Lawrence agreed to review safe sleep regulations by 1/10/24.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on file review, the licensee did not comply with the section cited above in two out of three persons did not complete mandated reporter training within the last two years which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
01/10/2024
Plan of Correction
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2
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4
The licensee stated the two persons will complete mandated reporter training. The licensee agreed to send proof of completion to LPA by 1/10/24.
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:
01/03/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/03/2024
LIC809
(FAS) - (06/04)
Page:
5
of
8
Document Has Been Signed on
01/04/2024 08:09 AM
- It Cannot Be Edited
Created By:
Nicolette Cunningham
On
01/03/2024
at
02:48 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:
LAWRENCE-SAMPSON FAMILY CHILD CARE HOME
FACILITY NUMBER:
475407728
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
01/03/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(10)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (10) A signed and dated copy of the Notice of Employee Rights [LIC 9052, (Rev. 03/03)] as required by Section 102416(a) and Section 102417.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on file review, the licensee did not comply with the section cited above in one employee did not receive notification of employee rights which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
01/10/2024
Plan of Correction
1
2
3
4
Licensee Lawrence stated she will provide Notice of Employee RIghts to Staff 1. Licensee Lawrence stated she will send proof to LPA by 1/10/24.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on file review, the licensee did not comply with the section cited above in one out of three employee files did not contain immunization records which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
01/10/2024
Plan of Correction
1
2
3
4
Licensee Lawrence stated she will obtain immunization records for Staff one and submit to CCL by 1/10/24.
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:
01/03/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/03/2024
LIC809
(FAS) - (06/04)
Page:
6
of
8
Document Has Been Signed on
01/04/2024 08:09 AM
- It Cannot Be Edited
Created By:
Nicolette Cunningham
On
01/03/2024
at
02:48 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:
LAWRENCE-SAMPSON FAMILY CHILD CARE HOME
FACILITY NUMBER:
475407728
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
01/03/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on file review, the licensee did not comply with the section cited above in one child's file did not contain emergency information which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
01/10/2024
Plan of Correction
1
2
3
4
The licensee stated she will obtain LIC700 for Child 2 and submit a copy to CCL by 1/10/24.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
01/03/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/03/2024
LIC809
(FAS) - (06/04)
Page:
7
of
8