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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623567
Report Date: 07/27/2022
Date Signed: 07/27/2022 02:05:15 PM

Document Has Been Signed on 07/27/2022 02:05 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:RONINGER, BONNIEFACILITY NUMBER:
343623567
ADMINISTRATOR:RONINGER, BONNIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 413-8640
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
07/27/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Bonnie RoningerTIME COMPLETED:
02:30 PM
NARRATIVE
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On Wednesday, July 27th, 2022, Licensing Program Analyst (LPA) Kelly Ferrara and Licensing Program Manager (LPM) Natalie Dunaway conducted a plan of correction inspection and met with Licensee Bonnie Roninger. LPA and LPM observed there were currently ten children in care with the Licensee and an assistant.

During today's inspection, LPA and LPM conducted a health and safety inspection and observed Licensee, assistant, and children's files. LPA observed the fingerprint roster from Guardian and observed the assistant is now fingerprint cleared and associated to the facility. All of the required forms were present in the assistant's file including the LIC 508 and Livescan form. LPA was able to clear the citation and provide a letter as proof.

LPA and LPM observed the Licensee and assistant had completed the Mandated Reporter training and received a certificate. LPA was able to clear the citation and provide a letter as proof.

LPA and LPM observed that the children's files did not have the Medical Consent form (LIC 627) or the Parent's Rights form (LIC 995). LPA observed that some of the files had a signature on the LIC 700 but the entire form was not completed.

See 809 D for additional citations issued. Exit interview was conducted and a copy of the report was given to the Licensee. A notice of site visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2022
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
Document Has Been Signed on 07/27/2022 02:05 PM - It Cannot Be Edited


Created By: Kelly Ferrara On 07/27/2022 at 01:42 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: RONINGER, BONNIE
FACILITY NUMBER: 343623567

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2022
Section Cited
CCR
102421(b)

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(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7). This requirement was not met as evidenced by: LPA did not observe the LIC 627 Medical Consent form in any of the children's files. This is a potential health and safety risk to children in care.
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Licensee shall have each parent complete the form to keep in the child's file. Licensee shall send a copy of the forms to LPA by POC due date.
Type B
08/19/2022
Section Cited
CCR
102419(d)(1)

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(d) At the time of acceptance of each child into care...(1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. This requirement was not met as evidenced by:
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Licensee shall have each parent complete the form to keep in the child's file. Licensee shall send a copy of the forms to LPA by POC due date.
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LPA did not observe the LIC 995 Parent's Rights form in any of the children's files. This is a potential health and safety risk to children in care.
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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:Natalie Dunaway
LICENSING EVALUATOR NAME:Kelly Ferrara
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2022


LIC809 (FAS) - (06/04)
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