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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620616
Report Date: 08/29/2022
Date Signed: 08/29/2022 01:48:01 PM

Document Has Been Signed on 08/29/2022 01:48 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:WADE, ERINFACILITY NUMBER:
313620616
ADMINISTRATOR:WADE, ERINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 847-2187
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
08/29/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Erin WadeTIME COMPLETED:
02:00 PM
NARRATIVE
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On August 29th, 2022, Licensing Program Analyst (LPA) Jeremey McClain met with Licensee Erin Wade in order to conduct a Plan of Correction inspection. Upon arrival, LPA observed care and supervision of two preschool age children, an infant, and a school age child.

On May 26th, 2022, Licensee was issued Type B deficiencies for not having record of children’s immunization's. Licensee was cited again on August 11th, 2022 after failing to correct the deficiency by the original due date. A plan of correction was discusse and a new date was of August 19th, 2022 was agreed upon for licensee to bring the deficiency into compliance.

As of today, the violation has not been brought to compliance. Licensee stated that she has not been able to gather immunization records from parents.

A Civil Penalty of $100 was issued due to failure to correct violation of 10248(g) within the specified length of time. This violation was cited on the subsequent 809-D page of the report.

This report was reviewed with licensee and an exit interview was conducted. A Notice of Site Visit was provided and shall remain posted for 30 days. LPA provided Licensee with Appeal Rights.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2022
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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Document Has Been Signed on 08/29/2022 01:48 PM - It Cannot Be Edited


Created By: Jeremey McClain On 08/29/2022 at 01:37 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: WADE, ERIN
FACILITY NUMBER: 313620616

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/02/2022
Section Cited
CCR
102418(g)

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g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.This requirement is not met as evidenced by: Licensee stated that she has not attained or documented immunization records for children in care.
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Licensee stated that she has asked parents for records, but they have not provided them to her. Licensee stated that she will attain and record immunization records for children in care and send proof to LPA by POC due date 09/02/2022.
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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:Jeremey McClain
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2022


LIC809 (FAS) - (06/04)
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