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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483007744
Report Date: 12/22/2021
Date Signed: 12/22/2021 01:25:43 PM

Document Has Been Signed on 12/22/2021 01:25 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:LINNEAR, GLORIA FCCHFACILITY NUMBER:
483007744
ADMINISTRATOR:LINNEAR, GLORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 422-2075
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 8DATE:
12/22/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Licensee Gloria LinnearTIME COMPLETED:
01:40 PM
NARRATIVE
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Licensing Program Analysts ( LPAs), Augustin and Hernandez Torres conducted a required Case management- Leagal/Non-Compliance visit to follow up with the licensee on the Plan of Correction from the June 09th 2021 Non-Compliance Conference (NCC), which included discussion of:

- All staff would undergo immediate training
- Facility Manager (S1) would complete 20 hours of early childhood development online learning course prior to the 90th day of S1's probationary period ending
- There would be a search for new staff hires
- Licensee's (LS) voluntary agreement to participate in the departments Technical Support Program (TSP)

LPAs Augustin and Hernandez Torres asked LS for proof of the completed training and further clarification of what the training included. LS was not able to produce proof of attendance or completion of all staff training and completion of Early childhood development courses for S1. LS and S1 stated they attempted to inquire about early childhood education courses and training through Solano family and children services and Community College three times between June 2021-November 2021, however; there was a delay in registering for the course. Licensee has agreed to schedule and register for an early childhood development course(s) and provide proof of registration for both LS and S1 to the department by 01/22/2022. LS stated three prospective staff went to get live scanned on 12/21/2021 and LS anticipates completion of staff on-boarding before 01/01/2022. LS also stated she had been in contact with the TSP as of 12/20/2021 and is waiting for the holidays to pass and settle to participate in the program.

Two staff's (LS and S1) records were reviewed at 10:04AM, S1's record did not contain evidence of negative TB clearance, and proof of immunity against Measles. S1 intends to obtain required staff immunization on 12/23/2021. Eight children's (C1-C8) records were reviewed at 10:46AM and records reviewed revealed C1, and C3-C8's LIC 9224 did not contain parental/guardian or authorized representative's signatures to notify of the type A deficiency issued in on May 03rd 2021, and the attendance of the NCC.

This report was reviewed and discussed with Licensee the following Title 22 deficiencies were cited on 809-D
Notice of Site Visit shall be posted for 30 days. Appeal rights were provided
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2021
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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Document Has Been Signed on 12/22/2021 01:25 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 12/22/2021 at 11:46 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
, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: LINNEAR, GLORIA FCCH
FACILITY NUMBER: 483007744

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/05/2022
Section Cited
HSC
1596.8595(c)(3)

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The licensee shall require each recipient of the licensing report described in paragraph (1) pertaining to a complaint investigation to sign a statement indicating that he or she has received the document and the date it was received.
This requirement is not met as evidenced by. . .
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Licensee stated as soon as the parents/ guardians come in today I will have the parents sign the document and place them in the children's file. Licensee will email/scan proof of both the LIC 9224s signed by each parent.
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Children's records reviewed revealed C1, and C3-C8's LIC 9224 did not contain parental/guardian or authorized representative's signatures to notify of the type A deficiency issued in on May 03rd 2021, and the attendance of the NCC. This poses a potential health and saftey risk to children in care.
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email: elpidia.hernandez-torres@dss.ca.gov
Phone: (707) 588-5038
Type B
01/05/2022
Section Cited
CCR102369(b)(9)

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Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.
This requirement is not met as evidenced by. . .
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Licensee stated S1 will pick up TB clearance tommorow 12/23/2021. Licensee will email copy of negative TB to LPA Hernandez Torres.
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Staff records reviewed at 10:04AM revealed S1's record did not contain evidence of negative TB clearance.This poses a potential health and saftey risk to children in care.
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email: elpidia.hernandez-torres@dss.ca.gov
Phone: (707) 588-5038
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:Leslie Lepori
LICENSING EVALUATOR NAME:Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/22/2021 01:25 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 12/22/2021 at 12:41 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
, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: LINNEAR, GLORIA FCCH
FACILITY NUMBER: 483007744

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2022
Section Cited
HSC
1597.622(a)(1)

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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 has not been met as evicenced by. . .
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Licensee stated S1 will stop by the doctors office and attempted to get a copy of the measles immunization and email the proof to LPA Hernandez Torres. If licensee is not able to receive the items by 01/10/2021 licensee will call LPA to request additional time.
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Staff records reviewed at 10:04AM revealed S1's record did not contain proof of immunity against the measles. This poses a potential health and saftey risk to children in care.
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email: elpidia.hernandez-torres@dss.ca.gov
Phone: (707) 588-5038

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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:Leslie Lepori
LICENSING EVALUATOR NAME:Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2021


LIC809 (FAS) - (06/04)
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