Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455406119
Report Date: 04/24/2017
Date Signed 04/24/2017 03:19:34 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:MANN, DELLENE FAMILY CHILD CARE HOMEFACILITY NUMBER:
455406119
ADMINISTRATOR:MANN, DELLENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 440-5966
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:14CENSUS: 8DATE:
04/24/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Dellene MannTIME COMPLETED:
03:25 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. Normal operating hours are Monday-Friday, 7:15 am - 6:30 pm. During today's visit the home and grounds were toured and the licensee was operating within the licensed capacity. The licensee's pediatric CPR and First Aid (expire 12/31/17) cards are current. The items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Licensee stated that there are no poisons in the facility and none were observed during today's visit. There was a working smoke detector, carbon monoxide detector and fire extinguisher in the home. The licensee 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. The licensee was provided a copy of A Child Care Provider's Guide to Safe Sleep. The licensee did not have evidence of required immunization records on file. 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. The following violations of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal rights were provided.
Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 895-5948
LICENSING EVALUATOR NAME: Patricia PachecoTELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2017
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: MANN, DELLENE FAMILY CHILD CARE HOME
FACILITY NUMBER: 455406119
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2017
Section Cited
H&S 1597.622
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Staff Immunizations.Commencing September 1, 2016, a person shall no t be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee was unable to provide evidence of immunity against measles and pertussis for herself or her assistants during the visit.
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The licensee agreed to obtain evidence of immunity against measles and pertussis for herself and her assistants. Evidence shall be sent to CCLD by 5/24/17.
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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: 04/24/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2017
LIC809 (FAS) - (06/04)
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