Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393617334
Report Date: 10/13/2016
Date Signed 11/21/2016 03:34:07 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:HAMILTON, MONICAFACILITY NUMBER:
393617334
ADMINISTRATOR:HAMILTON, MONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 751-6857
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:14CENSUS: 3DATE:
10/13/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Monica HamiltonTIME COMPLETED:
03:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Emerita Curiel met with Licensee, Monica Hamilton, for a Random Annual Visit and toured areas of the home accessible to the children. Off-limit areas: All bedrooms, living room, second bathroom. Census was 3 children. Licensee stated there are no new residents in the home since licensure. Adult residents have criminal record clearances. Hours of operation: M-F 6:00 am to 6:00 pm.
Licensee did not have a current CPR/First Aid certificates, posted 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 and locked in a kitchen door. Fire extinguisher carbon monoxide and smoke detector meet regulations. The backyard was fenced and there were no bodies of water. LPA observed the play structure was broken. Licensee stated children are not allowed to play on the broken part and the replacement part has been ordered. Licensee stated she will send LPA pictures once the play structure is repaired.
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 provided information on the new immunization requirements, and web site information.

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: 10/13/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2016
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 2


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: HAMILTON, MONICA
FACILITY NUMBER: 393617334
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/14/2016
Section Cited
102416(c)
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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 cannot locate her current CPR/First Aid card.
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Licensee stated she will send CCL a copy of her current CPR card by 11/14/16.
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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: 10/13/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2016
LIC809 (FAS) - (06/04)
Page: 2 of 2