Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455400688
Report Date: 02/13/2017
Date Signed 02/13/2017 01:48:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:GIBSON-CASSIDY, ELAINE FAMILY DAY CAREFACILITY NUMBER:
455400688
ADMINISTRATOR:GIBSON-CASSIDY, ELAINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 605-0930
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:14CENSUS: 2DATE:
02/13/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Patty DessauerTIME COMPLETED:
01:55 PM
NARRATIVE
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(1) A visit was made to the facility by LPA Patricia Pacheco. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During today's visit the home and grounds were toured and the licensee was operating within the licensed capacity. The licensee was not present during the visit. The assistant's pediatric CPR and First Aid (expire 11/30/18) cards are current. The bedrooms and side yard are off limits and have been made inaccessible by means of locked doors and a high latch. The items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. The assistant stated that there are no poisons in the home and none were observed during today's visit. LPA inspected the carbon monoxide detector with the assistants and observed that it was not functioning. There was a working smoke detector and fire extinguisher in the home. The assistant stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's visit. The children use the fenced backyard as the outdoor play area. There is an above ground swimming pool in the back section of the backyard. The pool has a five foot chain link fence; there is a waiver in place to allow slats in the fence and the conditions of the waiver are being met. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. All licensing reports are public information and must be made available upon request. This report was reviewed and discussed with the licensee's assistant.
Notice of Site Visit shall be posted for 30 days from today's visit.

The following violations of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Reports citing Type A violations are to be provided to parents/guardians of children currently in care of the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 895-5948
LICENSING EVALUATOR NAME: Patricia PachecoTELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2017
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: GIBSON-CASSIDY, ELAINE FAMILY DAY CARE
FACILITY NUMBER: 455400688
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/10/2017
Section Cited
H&S1597.622
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Employee/Volunteer Immunization: Commencing Sept 1, 2016, a person shall not be employed or volunteer at a FCCH if he or she has not been immunized against influenza, pertussis, & measles. Each employee/volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. Proof of immunization's not available for licensee and assistant(s).
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The licensee agrees to provide proof of having been immunized against influenza, measles, and pertussis for herself and assistant(s) as required.

Proof of correction shall be submitted to CCLD on or before 03/10/17.
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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: Jordan MonathTELEPHONE: (530) 895-5948
LICENSING EVALUATOR NAME: Patricia PachecoTELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2017
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: GIBSON-CASSIDY, ELAINE FAMILY DAY CARE
FACILITY NUMBER: 455400688
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/14/2017
Section Cited
H&S 1597.543
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Carbon monoxide detectors: Every FCCH for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12.

The home did not have a functioning carbon monoxide detector as required.
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The licensee agrees to ensure that there is a functioning carbon monoxide detector in the facility at all times. The licensee agrees to submit evidence that the carbon monoxide detector is functioning to CCLD on or before 02/14/2017.
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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: Jordan MonathTELEPHONE: (530) 895-5948
LICENSING EVALUATOR NAME: Patricia PachecoTELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2017
LIC809 (FAS) - (06/04)
Page: 2 of 3