Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390314556
Report Date: 01/17/2017
Date Signed 01/18/2017 09:08:23 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:TAYLOR, DEBRAFACILITY NUMBER:
390314556
ADMINISTRATOR:TAYLOR, DEBRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 477-9490
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:12CENSUS: 15DATE:
01/17/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Debra TaylorTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Emerita Curiel met with Licensee, Debra Taylor for a Random Annual Visit and toured areas of the home accessible to the children. Off-limit areas: Master bedroom, garage, west side of backyard and shed. Census was 2 infants, 9 preschoolers, and 4 school age children, making it a total of 15 children at the time of the visit. Licensee stated there are no new residents in the home since licensure. Adult residents have criminal record clearances. Hours of operation: M-F 7:00 am to 5:00 pm.

Licensee has a current CPR/First Aid certificates, expiration date 3/2017. Licensee posted day care License, Parent's Rights and current Emergency Disaster Plan. LPA reviewed several children's records. Toys appear to be safe. LPA observed cleaning compounds properly stored out of children's reach. Sharp utensils are stored on the kitchen counter. Fire extinguisher, carbon monoxide and smoke detector meets regulations.Licensee stated there are no weapons in the home.

This facility is not providing Incidental Medical Services-IMS at this time. LPA discussed IMS services and the requirement to create a plan of operation. Specifics on the plan can be found in the family child care home evaluator manual (FCCH EM) Policy 102417. LPA discussed the new licensing requirements AB 792 and LPA gave licensee 30 days to get the immunization's.LPA discussed safe sleeping practices for infants and requirement to notify the department prior to making changes to off-limit areas, or making alterations to the building. LPA provided information on the new immunization requirements, and web site information, so that licensee can stay current in the requirements of the Department. The web site is (www.ccld.ca.gov).

Deficiencies are cited on the subsequent pages of this report under the California Code of Regulations, Title 22.The licensee was provided a copy of their appeal rights. Exit interview conducted. Notice of Site Visit was provided.

SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Emerita CurielTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2017
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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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: TAYLOR, DEBRA
FACILITY NUMBER: 390314556
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/18/2017
Section Cited
102416.5(a)
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Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided.
LPA observed 2 infants, 9 preschoolers, and 4 school age children, making it a total of 15 children at the time of the visit.
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POC: Licensee stated the assistants grandaughter was in care due to an emergency. Licensee stated she understood ratios and stated she will ensure this will not happen again. LPA asked Licensee to write a plan of correction and send it via email by 1/18/17.
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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: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Emerita CurielTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2017
LIC809 (FAS) - (06/04)
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