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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623779
Report Date: 11/09/2021
Date Signed: 11/09/2021 02:12:33 PM

Document Has Been Signed on 11/09/2021 02:12 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:SUNDAY,GREGORY JR.FACILITY NUMBER:
343623779
ADMINISTRATOR:SUNDAY, GREGORY JRFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 904-2089
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 0DATE:
11/09/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Gregory Sunday, Jr.TIME COMPLETED:
02:30 PM
NARRATIVE
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On November 9, 2021 at 1:30 PM, Licensing Program Manager, Roxana Saravia and Licensing Program Analyst, Tanya Washington met with Licensee Gregory Sunday, Jr., for a plan of correction inspection regarding the deficiencies cited on 09/27/2021. Facility was cited for incomplete or missing children's records and Licensee's girlfriend, Aireonna Dunham was providing care to children alone and she did not have a current CPR and First Aid card or an assistant file.

Upon arrival to the facility at 10:30 AM, Aireonna had three children under her care, however she stated that she had an emergency and had to leave the facility with daycare children. Licensee Sunday, Jr., arrived to the facility at 1:30 PM, without any daycare children. At 1:30 PM, there were no day-care children present and the only adult in the home is Gregory Sunday, Jr. Licensing staff conducted file reviews of thirteen children, six out of thirteen children did not have a vaccination record.

Licensee Sunday and Aireonna Dunham have completed the required EMSA certified CPR and First Aid course on 10/02/2021 and their certificates are valid until 10/02/2023.

Aireonna is still missing the required shot record and the licensing forms are not complete.

One Type B citation is still pending for children's records.


Notice of site visit posted.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2021
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 11/09/2021 02:12 PM - It Cannot Be Edited


Created By: Tanya Washington On 11/09/2021 at 01:58 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: SUNDAY,GREGORY JR.
FACILITY NUMBER: 343623779

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/19/2021
Section Cited
CCR
102421(1)(b)

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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 is not met as evidenced:
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Licensee stated that he was confused about the information requested by LPA during the last inspection and did not realize he needed proof of vaccination cards.
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During the records review six out of thirteen children were missing a vaccination record.
This is a potential risk to the health and safety of 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:Roxana Saravia
LICENSING EVALUATOR NAME:Tanya Washington
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2021


LIC809 (FAS) - (06/04)
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