Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343610520
Report Date: 01/31/2018
Date Signed 01/31/2018 11:45:49 AM

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:
01/31/2018
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Monica AutryTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Amie Randa made an unannounced Plan of Correction (POC) Inspection and met with Director Monica Autry to clear a Type A deficiency cited on 01/28/2018 for Care and Supervision of an infant who was not supervised in the nap area. Upon arrival todays census was 22 children being supervised by seven staff members. LPA observed that there were no infants unsupervised in the nap area; therefore the deficiency is cleared.

In addition while LPA was at the facility she observed that the facility purchased new changing pads, which are at least one inch. LPA also observed that the Director created a staff file for the staff member that was missing a file, clearing both Type B deficiencies.

The facility has until 02/16/2018 to clear the remaining deficiencies; which are Infant Care Personal Services and SB 792 Immunization Regulation.

No Title 22 Deficiencies cited were observed in the areas that were evaluated. LPA read this report to the licensee, she stated understands today’s inception. 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: 01/31/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2018
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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