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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623957
Report Date: 04/13/2023
Date Signed: 04/13/2023 04:38:10 PM

Document Has Been Signed on 04/13/2023 04:38 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:SHANNON, ERIKAFACILITY NUMBER:
343623957
ADMINISTRATOR:SHANNON, ERIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 274-1517
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
04/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Erika ShannonTIME COMPLETED:
04:45 PM
NARRATIVE
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On April 13, 2023 at 1:40pm Licensing Program Analyst (LPA) Mandie Goodwin arrived at facility for the purpose of an unannounced required 1-year inspection. Licensee’s assistant opened the door and LPA introduced self and reason for visit. Assistant stated that they were a helper and would prefer to wait until licensee was home. LPA asked if daycare children were present, and assistant stated that there were 2 children. LPA stated that they do have inspection authority to conduct health and safety inspections when children were present. Assistant stated “one moment’ and closed the door. LPA waited approximately 3 minutes and knocked on the door. LPA called licensee and asked to be let in to facility. Approximately 7 minutes after initial arrival licensee came to the door and let LPA in. Licensee stated that she had just gotten home and that it was the assistant’s first day and she had told her not to open the door because they live on a not-great street. LPA restated inspection authority regulation.

LPA asked assistant’s name and did not observe the assistant to be fingerprint associated with the facility. Licensee stated that the assistant works in another family child care home and she did not know she had to be associated to both licenses. LPA looked up individual in the fingerprint background check registry and observed individual to be listed as “in process” and not yet cleared. There were no other adults at the time of visit. The facility days and hours of operation are 24/7. Overnight care was discussed.

LPA toured the facility and a health and safety inspection was conducted in all areas accessible to children. The off-limits areas include the garage, kitchen, and entire upstairs. Licensee acknowledged that children must never enter these areas. LPA observed the required postings, a fully charged fire extinguisher, and smoke and carbon monoxide detectors. Per Licensee, there are no weapons in the home. No bodies of water were observed today. Toxic and hazardous items are inaccessible to children. Outdoor play space is fenced. Fireplace is appropriately screened.
(Report continues LIC809-C)
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2023
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 04/13/2023 04:38 PM - It Cannot Be Edited


Created By: Mandie Goodwin On 04/13/2023 at 03:30 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: SHANNON, ERIKA
FACILITY NUMBER: 343623957

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above by having an adult providing care and supervision to children who wasn't fully background check cleared which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2023
Plan of Correction
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Licensee signed an attestation that she will not have the assistant work in the home until full background check clearance is granted.
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:Seychelle De Luca
LICENSING EVALUATOR NAME:Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/13/2023 04:38 PM - It Cannot Be Edited


Created By: Mandie Goodwin On 04/13/2023 at 03:30 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: SHANNON, ERIKA
FACILITY NUMBER: 343623957

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above in by not having a current mandated reporter training available which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/28/2023
Plan of Correction
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Licensee will locate current mandated reporter training or retake the course and submit a valid certificate to LPA by POC due date.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in by having an assistant providing care and supervision to children without licensee present and not having access to a current CPR certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/27/2023
Plan of Correction
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Licensee will submit an attestation that she understands that assistants must have CPR training if left alone with children in care.
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:Seychelle De Luca
LICENSING EVALUATOR NAME:Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2023


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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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: SHANNON, ERIKA
FACILITY NUMBER: 343623957
VISIT DATE: 04/13/2023
NARRATIVE
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LPA reviewed the enrolled children’s files, which were observed to be complete. A current children’s roster was observed. Licensee has record of conducting fire drills at least every six months. Per record, last drill was conducted in October 2023. LPA observed licensee’s CPR and First Aid card which expires 1/25/24. LPA did not observe a current mandated reporter. Assistant had a current mandated reporter training, but did not have a current CPR available for review. Assistant was proving care and supervision without licensee present. LPA discussed the requirement of renewing mandated reporter training every 2 years. LPA reviewed and provided the Family Child Care Home Entrance Checklist. LPA reminding licensee about open door policy, children's personal rights, and smoking prohibition for child care homes.
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 submitting 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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of 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. Continued on 809-C
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
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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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: SHANNON, ERIKA
FACILITY NUMBER: 343623957
VISIT DATE: 04/13/2023
NARRATIVE
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Title 22 deficiencies were observed and are cited on LIC 809-D. Licensee acknowledges, that for TYPE A DEFICIENCIES ONLY upon receipt, Licensee shall post LIC 809-D with Type A deficiency 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. LIC9224 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 License. This report also documents that a civil penalty was assessed for $100 for an uncleared adult. LIC9224 and Appeal Rights were provided and explained. interview was conducted and report was reviewed with the Licensee Erika Shannon.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
LIC809 (FAS) - (06/04)
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