483010013-7-19-2022-01-CC-EHTS-CGH2P5-20220719173346

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483010013
Report Date: 07/19/2022
Date Signed: 07/19/2022 05:34:00 PM

Document Has Been Signed on 07/19/2022 05:34 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	LITTLE BLESSINGS DAYCARE-INFANT		FACILITY NUMBER:	483010013
ADMINISTRATOR:	BARRON BOTELLO, MARTHA		FACILITY TYPE:	830
ADDRESS:	717 KENTUCKY STREET		TELEPHONE:	(707) 720-9706
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY: 7	TOTAL ENROLLED CHILDREN: 7	CENSUS: 7	DATE:	07/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:19 AM
MET WITH:	Licensee MARTHA BARRON BOTELLO		TIME COMPLETED:	05:40 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An annual inspection was made to the facility by Licensing Program Analyst (LPA), Elpidia Hernandez Torres. The facility file was reviewed prior to this inspection. A review of the personnel report on 07/19/2022 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. This program is operated by a private entity. The facility’s operating hours are 06:30AM-06:00PM, Monday – Friday. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. Licensee stated there were no poisons on the premises. The regulation that poisons are locked with a combination or key lock was reviewed. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces were clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors through the use of a water dispenser and outdoors through sippy cups. The children’s bathrooms were in safe and sanitary condition. A current menu was posted at the entrance of the facility. Food prep areas are clean. Food is properly stored and free of contamination. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is dirt as cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The licensee stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and there were seven infants being supervised by one teachers and one aide. The facility was operating within the licensed capacity. At least one staff member present during the visit possessed current CPR and First Aid certifications. Seven children’s records were reviewed at 11:47AM, and contained identification forms with authorized representative information, as well as medical assessments. All seven infants were missing the admissions agreement an advisory note was issued. All seven infants were missing a services and needs plan a deficiency was cited. continued on 809-C

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: LITTLE BLESSINGS DAYCARE-INFANT	FACILITY NUMBER: 483010013
	VISIT DATE: 07/19/2022

NARRATIVE

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Two staff records were reviewed, and contained health screening forms. The sign in/out procedure was reviewed and in compliance

Licensee was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/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-and-resources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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: http://www.ada.gov/childqanda.htm

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee MARTHA BARRON BOTELLO .

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/19/2022 05:34 PM - It Cannot Be Edited

Created By: Elpidia Hernandez Torres On 07/19/2022 at 05:16 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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: LITTLE BLESSINGS DAYCARE-INFANT	FACILITY NUMBER: 483010013
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101419.2(a)

Infant Needs and Services Plan

(a) Prior to the infant's first day at the center, the infant care center director or assistant director shall complete a needs and services plan for the infant. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, none of the seven children enrolled had an infant services and needs plan. Licensee believed the LIC 9227 was the sole document required for the infants services and needs plan. 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.
	POC Due Date: 08/02/2022
	Plan of Correction
1 2 3 4	LPA Hernandez Torres reviewed regulation with licensee. Licensee agreed to create a templete for an infants services and need plan and work with guardians to complete the doucment. LPA Printed out infant food services and infant needs and services regulations for licensee. LPA Hernnadez Torres will return the facility on or before July 28th to review the seven infant's files to ensure infant services plan was in their file.

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:

Leslie Lepori

LICENSING EVALUATOR NAME:

Elpidia Hernandez Torres

LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

LIC809 (FAS) - (06/04)

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