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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293623969
Report Date: 06/28/2024
Date Signed: 06/28/2024 01:24:13 PM

Document Has Been Signed on 06/28/2024 01:24 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BECERRA, LAURAFACILITY NUMBER:
293623969
ADMINISTRATOR/
DIRECTOR:		LAURA BECERRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 798-3002
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95945
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
06/28/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:35 AM
MET WITH:Laura BecerraTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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At 11:35am on 6/28/2024, Licensing Program Analyst (LPA) Matthew Gallo met with licensee Laura Becerra for the purpose of an unannounced required annual inspection. Today's census included 7 children, consisting of 2 school aged children, 3 preschool children, and 2 infants. Licensee stated that no other adults were present in the home.

Licensee guided LPA on a tour of the facility, and a health and safety inspection was conducted in all areas accessible to children. Off-limits areas include front bedrooms, master bathroom, back side yard, and garage. Upon arrival, LPA observed 6 children in the on-limit areas of the home. During visit, LPA asked if licensee would mind showing him inside the master bedroom, which is one of the off-limit front bedrooms, after LPA believed he heard noises from inside. Licensee opened the door, and LPA observed a sleeping infant in a pack and play inside the off-limit area. Licensee acknowledged that children must never enter off-limit areas.

LPA observed the required postings, a working phone, 2A10BC fire extinguisher, and a functioning smoke detector. The carbon monoxide detector had been removed from the wall, and licensee could not produce one during the visit. Per licensee, there are no weapons in the home, and LPA did not observe bodies of water at the facility. Toxic and hazardous items are inaccessible to children. Fireplace is barricaded to prevent access to children, as are the top and bottom of the stairs from the porch to the outdoor play space. Outdoor play space is fenced.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Report continues on 809-C

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BECERRA, LAURA
FACILITY NUMBER: 293623969
VISIT DATE: 06/28/2024
NARRATIVE
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LPA reviewed 7 children’s files. Through record review and interview, LPA determined that licensee was not documenting 15 minute sleep checks on sleeping infants. A current roster is being maintained and fire and disaster drills are documented. Current CPR and First Aid certification was verified and expires 10/2024, and AB 1207 Mandated Reporter Training was verified for the licensee and expires 7/2025.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Title 22 deficiencies are cited on the subsequent pages of this report.



Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided. Report continues on 809-C
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024
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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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BECERRA, LAURA
FACILITY NUMBER: 293623969
VISIT DATE: 06/28/2024
NARRATIVE
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Exit interview conducted and report was reviewed with the licensee, Laura Becerra. A notice of site visit was given and must remain posted for 30 days.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024
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Document Has Been Signed on 06/28/2024 01:24 PM - It Cannot Be Edited


Created By: Matthew Gallo On 06/28/2024 at 12:55 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BECERRA, LAURA
FACILITY NUMBER: 293623969

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in the case of an infant sleeping inside one of the off-limit front bedrooms behind a closed door, which poses an immediate health, safety, or personal rights risk to persons in care.
POC Due Date: 07/01/2024
Plan of Correction
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Licensee stated that they will move the pack and play of the sleeping infant to the living room starting today, and acknowledges that children cannot be in off-limit areas. LPA will conduct to ensure compliance.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Keven Peters
LICENSING EVALUATOR NAME:Matthew Gallo
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2024


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Document Has Been Signed on 06/28/2024 01:24 PM - It Cannot Be Edited


Created By: Matthew Gallo On 06/28/2024 at 12:55 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BECERRA, LAURA
FACILITY NUMBER: 293623969

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home 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 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observaton and interview, the licensee did not comply with the section cited above by not being able to produce a working carbon monoxide detector during LPA's visit, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2024
Plan of Correction
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Licensee will send LPA video of testing a working carbon monoxide dector to LPA Gallo by text prior to the POC due date.
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interivew, the licensee did not comply with the section cited above in the case of 2 out of 2 infants, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2024
Plan of Correction
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Licensee will send LPA pictures of 15 minute sleep checks of the two infants for the weeks of 7/1/2024-7/12/2025 by the POC due date.
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:Keven Peters
LICENSING EVALUATOR NAME:Matthew Gallo
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2024


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