Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617889
Report Date: 01/27/2016
Date Signed 01/27/2016 04:36:14 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:SKELTON, BUDNIEFACILITY NUMBER:
343617889
ADMINISTRATOR:SKELTON, BUDNIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 397-0495
CITY:SACRAMENTOSTATE: CAZIP CODE:
95832
CAPACITY:14CENSUS: 6DATE:
01/27/2016
TYPE OF VISIT:Required - 5 YearUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Budnie SkeltonTIME COMPLETED:
04:45 PM
NARRATIVE
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LPA LeGuie met with licensee Budnie Skelton for the purpose of a 5 year comprehensive inspection. Her adult daughter, Dezeray Skelton, 4 infants and 2 preschool children were present upon entry. Licensee's adult daughter is not cleared to be at the facility.

A health and safety inspection was conducted inside and out. The home appeared orderly. LPA observed a working phone, 2A10BC fire extinguisher, first aid kit and a functioning smoke detector. Per licensee, there are no weapons in the home. No children were observed in parked cars. There are no accessible bodies of water on the premises. Toxic and hazardous items are inaccessible to children. Safe toys and comfortable accommodations were observed. Outdoor play area was fenced. Fireplaces, stairs and/or wall heaters in the home were appropriately barricaded to prevent access by children. This facility does not provide Incidental Medical Services (IMS). Licensee was advised to review the FCCH EM Policy 102417 for additional information regarding IMS.

Children's and facility records were reviewed. A civil penalty in the amount of $500 is being assessed for an unfingerprinted adult caring for children.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/ guardians of children who are currently enrolled as well as parents/ guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must acknowledge receipt of this report and citation by signing a LIC 9224, “ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS”. A copy of this form should be placed in each child file upon receipt from parent.


An exit interview was conducted. A notice of site visit was provided and should remain posted for 30 days for parental review. LIC 311D was discussed and provided. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of 3 years for public review upon request. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of this form. See 809D for deficiencies cited.

SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Eunique LeGuieTELEPHONE: 916-491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2016
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: SKELTON, BUDNIE
FACILITY NUMBER: 343617889
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/28/2016
Section Cited
102370(d)(1)
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102370(d)(1) Criminal Record Clearance. All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption as required by the Department.-LICENSEES ADULT DAUGHTER, DEZERAY SKELTON, WAS CARING FOR CHILDREN WITHOUT A CLEARANCE.
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BY 1/28/16, LICENSEE WILL SUBMIT PROOF OF LIVE SCAN FOR HER DAUGHTER, DEZERAY SKELTON.
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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) 263-5744
LICENSING EVALUATOR NAME: Eunique LeGuieTELEPHONE: 916-491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2016
LIC809 (FAS) - (06/04)
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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: SKELTON, BUDNIE
FACILITY NUMBER: 343617889
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/05/2016
Section Cited
102417(g)(8)
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102417(g)(8) Operation of a Family Child Care Home. All homes shall have a current roster of the children.-A CURRENT ROSTER IS NOT BEING MAINTAINED AT THE FACILITY.
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BY 2/5/16, LICENSEE WILL COMPLETE AND MAINTAIN A ROSTER FOR THE FACILITY. LICENSEE WILL SUBMIT PROOF TO LPA.
Type B
02/05/2016
Section Cited
102417(g9A1)
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102417(g)(9)(A)(1) Operation of a Family Child Care Home. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill.- A FIRE DRILL LOG IS NOT BEING MAINTAINED AT THE FACILITY.
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BY 2/5/16, LICENSEE WILL CONDUCT AND DOCUMENT DRILLS; PROOF WILL BE SENT TO LPA.
Type B
02/26/2016
Section Cited
102416(c)
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102416(c) Personnel Requirements. The Licensee and other personnel as specified shall complete training on preventive health practices including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.-LICENSEE DID NOT HAVE CURRENT CPR/FIRST AID.
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BY 2/26/16, LICENSEE WILL ENROLL IN A CPR/FIRST AID CERTIFICATION COURSE; PROOF OF COMPLETION WILL BE SENT TO LPA.
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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) 263-5744
LICENSING EVALUATOR NAME: Eunique LeGuieTELEPHONE: 916-491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2016
LIC809 (FAS) - (06/04)
Page: 3 of 3