Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343610520
Report Date: 07/24/2015 12:00:00 AM
Date Signed 07/24/2015 03:18:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:POPPY PATCH-PHASE IIIFACILITY NUMBER:
343610520
ADMINISTRATOR:AUTRY, MONICAFACILITY TYPE:
830
ADDRESS:9638 BUTTERFIELD WAYTELEPHONE:
(916) 845-4949
CITY:SACRAMENTOSTATE: CAZIP CODE:
95827
CAPACITY:60CENSUS: 29DATE:
07/24/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Monica AutryTIME COMPLETED:
03:30 PM
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1. Licensing Program Analyst (LPA) Dominick Conde met with the Director Monica Autry for an Annual/Random visit. LPA toured the facility, including all activity/classroom areas, food service area, restrooms and outdoor play areas. LPA reviewed care and supervision of children, staffing ratios, health related services, including medications and first aid supplies, furniture, drinking water and food service provisions. LPA observed that all medications are properly stored and still current. The facility's hours of operation are Monday to Friday 5:45 AM to 6:00 PM. During the visit LPA observed twenty-nine infants/toddlers being supervised by eight staff.

LPA observed all required forms to be posted. There were cribs available for each infant under 12 months old and cots for the older children. There are in-service plans for each infant in the infant classroom. LPA observed all infant classrooms have changing tables which are in reach of a sink and water access. There are adequate toys and equipment available for children. The restrooms were observed to be in working order. The facility provides breakfast, lunch, am/pm snack, and menus were posted in the facility.

LPA reviewed the sign/in-sign/out sheet. LPA reviewed staff and children's files today. All children's files reviewed today have emergency contact information and physician reports on file. All staff present during today's visit have health screening reports with TB test results. LPA observed that at least one staff member present today has current Pediatric CPR and First Aid. LPA explained the new requirements if providing Incidental Medical Services - IMS.

LPA advised the director of the Notice of Site Visit posting requirement. LPA provided the Licensing Agency website (www.ccld.ca.gov), so the director and/or staff may obtain updated licensing information, regulations, and forms.

In the areas that were evaluated, no deficiencies were cited during the visit.

Exit interview was conducted. Notice of Site Visit posted.
SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Dominick CondeTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2015
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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