Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304204980
Report Date: 11/07/2016
Date Signed: 11/07/2016 01:19:47 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:RASPPERRY, LAURA ANNFACILITY NUMBER:
304204980
ADMINISTRATOR:RASPPERRY, LAURA ANNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 871-3653
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY:14CENSUS: 6DATE:
11/07/2016
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Licensee- Laura RaspperryTIME COMPLETED:
01:40 PM
NARRATIVE
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Licensing Program Analyst, (LPA) Moore, arrived at the facility to conduct an annual required visit. LPA toured the facility, inside and outside, records were reviewed and the following was observed.
LPA was greeted by licensee and allowed entrance into the facility. Present was licensee, Laura Raspperry who was caring for 1 day care child in the kitchen area. Upon LPA's arrival to the facility, 6 day care children were present at the day care home, 5 children were in the family room with 2 adult assistants whom were licensee's adult children. Census was taken as followed: 6 day care children, (4 infants, and 2 preschoolers). Also present but not assisting with the day care children was licensee's husband whom was asleep in the room during LPA's arrival. A review of criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Appropriate fire extinguisher, carbon monoxide detector, and smoke detector were present and in operable condition; all hazardous items were inaccessible; toxins are locked; no guns or weapons present as stated by the Licensee; facility met posting requirements. Licensee's Pediatric CPR and First Aid Card will expire on 05/30/17, 2 Adult Assistant's Pediatric CPR and First Aid card will expire on 05/30/17. Children’s roster and fire drill log was reviewed. Age appropriate toys & equipment for ages served were available for indoor and outdoor play. The backyard is fenced and the pool in the backyard was gated and met regulations. LPA reviewed with licensee that children should be supervised at all times in the backyard. Licensee stated that children do not use the backyard area for play. Per licensee children use the front enclosed yard for outside play. Children and staff's files were reviewed. Licensee and Assistants did not have the required immunization's of Influenza, Pertussis, and Measles on file during today's visit. Licensee's husband had documentation of Influenza vaccination. LPA reviewed quarterly updates.
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm.
SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Jacqueline MooreTELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2016
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 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: RASPPERRY, LAURA ANN
FACILITY NUMBER: 304204980
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/07/2016
Section Cited
H&S1597.622(c)
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Employees or volunteers at family day care home; immunization requirements; records; exemptions The family day care home shall maintain documentation of the required immunization's or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.
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Licensee stated did not know that there were required immunization's for staff and assistants. Licensee agrees to submit verification of these immunization's to LPA Moore via email by due date of 12/07/16. Jacqueline.moore@dss.ca.gov
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Licensee and assistants did not have documentation of Influenza, Pertussis and Measles immunization's on file for review during today's visit. Licensee stated that she has had the Influenza vaccination and will request for documentation from the Doctor. Licensee's husband had documentation for the Influenza. This may be a potential health and safety risk to children 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: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Jacqueline MooreTELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2016
LIC809 (FAS) - (06/04)
Page: 3 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: RASPPERRY, LAURA ANN
FACILITY NUMBER: 304204980
VISIT DATE: 11/07/2016
NARRATIVE
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LPA reviewed areas accessible to day care children, which include the family room, living room, hallway bathroom, kitchen, 2 bedrooms to the left of the hallway which were used as napping rooms, front yard and back yard. There are 2 cats are 1 dog at the facility. The areas that were evaluated, deficiencies were observed, discussed and cited at the time of the visit. (See LIC 809D for specific deficiencies cited)
After a tour of the facility, review of children's and staff's files. The facility was found not to be in compliance with Title 22 regulations.
The following were discussed: Individuals who are 18 years of age or older living in the home must be fingerprinted cleared prior to presence in the facility. Live Scan tel# (800)315-4507, complete LIC9163. Criminal record clearances/exemption transfer requests (contact Licensing Office (714)703-2800 ask for Personnel ID#, fax Criminal Background Transfer Request form (LIC 9182) with copy of ID and LIC 508 to fax# (714)703-2831 prior to hiring staff.
LPA reviewed Unusual Incident Report form, advised to contact Licensing Officer of the Day within 24 hours and complete the Unusual Incident Report (LIC 624) within 7 days.
LPA reminded licensee of requirements of disaster drills, posting requirements, children records, mandated child abuse and injury/death reporting, SIDS and Never Shake a Baby, California passenger safety law, SB 792 (copy given), SB 277, and Complaint Bureau.
The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf
An exit Interview was conducted with licensee. Report was reviewed and discussed.

The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. The Notice of Site Visit was posted. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. LPA informed the licensee of how to access regulations and forms from CCLD websites: www.ccld.ca.gov or Myccl.ca.gov and/ or http://ccld.ca.gov/PG411.htm. This report is to be on file and accessible for public review at the facility for at least 3 years.

SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Jacqueline MooreTELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2016
LIC809 (FAS) - (06/04)
Page: 2 of 3