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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010165
Report Date: 08/28/2024
Date Signed: 08/28/2024 02:15:58 PM

Document Has Been Signed on 08/28/2024 02:15 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:PERKINS, JOYCE FCCHFACILITY NUMBER:
483010165
ADMINISTRATOR/
DIRECTOR:		PERKINS, JOYCEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 655-0922
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
08/28/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Joyce PerkinsTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analysts (LPA) Glenn Ouye and Selena Mariani arrived to perform an unannounced Case Management visit for a Legal/Non-Compliance quarterly visit.

The visit is being conducted to confirm that the following terms of the non-compliance conference are being upheld:
  • Ensure children are adequately supervised during the hours of operation.
  • Licensee advises she intends to hire more staff to assist with care and supervision.
  • Obtain a sufficient number of cribs approved by the Consumer Product Safety Commission available for infants that are unable to climb out of a crib.
  • Continue to conduct and document 15 minute checks while infant(s) nap.
  • Compliance with all infant Safe Sleep regulations.
  • Licensee agrees not to engage in conduct that is inimical to the health and safety of the children in care.

There were six children in care, one of which is an infant with the licensee providing care and supervision. Upon arrival one staff was supervising 4 children one of which were infants. The licensee arrived at approximately 1:25pm with two children. The infant (C1) was asleep and has outgrown a crib or pack and play. The C1 will be 2 years old in January 2025. LPA confirm with staff S1 that the infant has been asleep since 1pm. Based on record review of sleep log there was no documentation of 15 minute sleep check and log for C1. By 1:30pm there should have been two 15 minute entries on the log.
LPA Ouye and licensee discussed safe sleep regulations as a reminder of the regulations and the legal non-compliance agreement and the plan of correction.

Licensee was very professional while working with LPA Ouye and while providing care for the children who were attending her program.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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 08/28/2024 02:15 PM - It Cannot Be Edited


Created By: Glenn Ouye On 08/28/2024 at 01:56 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: PERKINS, JOYCE FCCH
FACILITY NUMBER: 483010165

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/06/2024
Section Cited
CCR
102425(j)(2)(D)

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Infant Safe Sleep-The provider shall supervise infants while they are sleeping and adhere to the following requirements-Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:
a.Date.b.Infant’s name.
c.Time of each 15-minute check.
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Licensee agrees to traing staff S1 with safe sleep regulations and have S1 sign letter stating they have been trained, understand the safe sleep regulation and will comply with the regulation. Licensee agrees to send LPA a letter to confirm the training and signature of staff who was trained.
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The requirement has not been met as evidenced by safe sleep log record review of child C1 at 1:30pm. There wee no sleep log entries for day which poses a potential health and safety risk to the child 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:Leslie Lepori
LICENSING EVALUATOR NAME:Glenn Ouye
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024


LIC809 (FAS) - (06/04)
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