Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343610520
Report Date: 01/18/2018
Date Signed 01/18/2018 04:44:00 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, 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: 22DATE:
01/18/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Monica AutryTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Amie Randa and Mary Ponce met with Director Monica Autry for an unannounced annual inspection. Today's census was 22 children and 11 staff members; one of which was not associated to the facility which is an immediate risk to children in care. LPAs toured the facility including all activity/classroom areas, food service area and restrooms. LPAs observed that furniture and equipment are in good condition, the food preparation area is kept clean and sanitized and the restrooms are safe and sanitary. The Director stated that the facility provided morning/afternoon snack and lunch; LPAs observed a current menu posted in.

LPAs reviewed the sign/in-sign/out sheet. LPAs observed that at least one staff member present during today’s inspection has current Pediatric CPR/First Aid that expires on 06/30/2019. LPAs observed that no poisons, cleaning compounds and medications are inaccessible to children. The Director stated that there are no firearms or bodies of water on the property.

LPAs observed that the changing table’s raised sides are at least three inches high, does not have a one inch padded surface and it is located near a sink. LPAs reviewed children's medical assessment: Physician Report, Identification and Emergency information, Infant’s Individual Feeding Plan and Infant’s Needs and Services plan. LPAs reviewed staff's educational requirements, including the Infant course and observed that the facility had the appropriate staffing to meet the Infant ratio. LPAs observed that one staff member did not have a file.

LPAs observed that all infant bottles brought from home are labeled, dated and returned daily. LPAs observed that the infants have sufficient nap equipment that meet Title 22 Regulations, the nap area is separate from the activity area; however a sleeping infant did not have direct supervision which is an immediate risk to the infant. LPAs advised the Director on Safe Sleep Practices and SIDS.
SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Amie RandaTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2018
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 III
FACILITY NUMBER: 343610520
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/18/2018
Section Cited
HSC
1596.7995
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(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center 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.
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POC: Director stated that she was not aware of the requirements for SB 792. Facility shall ensure that all staff have proof of immunization for Pertussis, Measles, and Influenza. This documentation shall be maintained in staff files. Proof of correction shall be sent to LPA by due date 02/16/2018.
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None of the employee files did not contain proof of immunizations to meet SB 792.
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Type B
01/18/2018
Section Cited
CCR
101217(b)
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Personnel Records. Personnel records shall be maintained for all volunteers and shall contain specified information. LPAs observed that one staff member did not have a file at the facility
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POC: The Director stated she will create a new file for the staff member. LPA Randa will return to check.
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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: Monica R FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Amie RandaTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2018
LIC809 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 III
FACILITY NUMBER: 343610520
VISIT DATE: 01/18/2018
NARRATIVE
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LPAs provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPAs advised the licensee of their responsibility to stay current in regards to new regulations.

LPAs discussed the Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care facility must have vaccinations against, Pertussis, Measles and Influenza. LPAs advised the Director that they can sign a declaration to be exempt from the influenza vaccinations however; Pertussis and Measles are not exemptible. To be exempt from Pertussis and Measles staff must have a medical exemption signed by a licensed physician. LPAs conducted file reviews and observed that the staff does not have proof that they have been immunization which is a potential risk to children in care.

LPAs discussed the Incidental Medical Services (IMS) policies with the Director and the facility already has a Plan for Providing IMS on file with the department.

LPAs informed the Director on the new regulation AB 1207- California Child Care Worker: Mandated Reporter Training. All staff must complete the training every two years starting January 1, 2018 and retain proof of completion in their facility file. The training can be could at: mandatedreporterca.com.

In the areas that were evaluated, six deficiencies were cited during the inspection. Title 22 Deficiencies have been cited on the attached LIC 809 D. Upon receipt of Type A citations, licensee shall post and provide copies of the LIC 809 D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Licensee must also keep the signed LIC 9224, acknowledging receipt of LIC 809 D in each child's file.

LPAs read this report to the license, she stated that she acknowledges and understands today’s inception. Appeal Rights were provided and Notice of Site Visit posted and the license understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Amie RandaTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2018
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 III
FACILITY NUMBER: 343610520
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/18/2018
Section Cited
CCR
101170(e)(2)
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Criminal Record Clearance. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility or Trustline. LPAs observed that one staff member was not associated to the
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POC: LPAs had the Director fill out the transfer request form, the LIC 508 and obtained a copy of the staff member's drivers license so LPA Randa can associate the staff member to the facility. LPAs advised the director on faxing the transfer requested to the office and calling the main
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facility. When LPAs asked the Director for the staff member's file to see if a transfer request was submitted to the office the Director said the staff member's file was missed placed. Civil Penalties were assessed.
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line to ensure the transfer went through.
Type A
01/18/2018
Section Cited
CCR
101229(a)(1)
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Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1). LPAs observed a sleeping infant alone in the nap room without direct supervision. When LPAs asked the Director
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to have a staff member go into the room to supervise the sleeping infant the staff member stayed in the facility area with the other teacher instead of going into the nap room. LPAs advised the staff on the importance of direct supervision.
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POC: LPA Randa will conduct a return POC inspection to ensure that the infants are directly supervised at all times.
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: Monica R FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Amie RandaTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2018
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 III
FACILITY NUMBER: 343610520
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/18/2018
Section Cited
CCR
101428(d)(3)
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Infant Care Personal Services: (d) When changing an infant's diapers, the following shall apply: (3) Soiled disposable diapers shall either be disposed of as recommended on the packaging or placed in an airtight container for daily disposal outside of the
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POC: The Director stated she would have a staff meeting to review Infant Care procedures. Director submit an agenda to LPA Randa by 2/16/2018 that all staff members signed off on.
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center. LPAs observed that staff disposed a poopy diaper in a trash can that did not have the lid. The trash can was in the bathroom and was accessible to the children. In addition it caused a malodorous smell in the classroom.
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Type B
01/18/2018
Section Cited
CCR
101439(h)(1)
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Infant Care Center Fixtures, Furniture, Equipment and Supplies: (h) Infant changing tables shall (1) Have a padded surface no less than one inch thick and be covered with washable vinyl or plastic. LPAs observed the changing table pads to be
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POC: Director stated that she would purchase pads for all three changing tables. LPA Randa will return to check.
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very thin and not at least 1 inch thick.
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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: Monica R FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Amie RandaTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2018
LIC809 (FAS) - (06/04)
Page: 4 of 5