390314373-3-4-2022-53-CC-LSCT-CC7VCH-20220304151909

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 390314373
Report Date: 03/04/2022
Date Signed: 03/04/2022 03:21:48 PM

Document Has Been Signed on 03/04/2022 03:21 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:	HAN, MARY		FACILITY NUMBER:	390314373
ADMINISTRATOR:	HAN, MARY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 463-7368
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95204
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 7	DATE:	03/04/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Licensee, Mary Han		TIME COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On March 4, 2022, Licensing Program Analysts (LPAs) Lauren Scott and LPA Christopher Jackson met with the facility representative, Mary Han, for the purpose of an unannounced annual inspection. There were seven children present at the time of inspection. Licensee's assistant, Loreen Gonzales, was also present during the inspection. Licensee's operating hours are Monday through Friday from 7:00 AM. to 5:30 PM. Facility representative, Mary Han, 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. A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include the laundry room. During today's inspection, licensee requested to make master bathroom off limits as well. Off limit areas are being made inaccessible by closed locked doors. LPA observed the required postings and a working phone. 3B40BC fire extinguisher meets regulations. LPA observed smoke and carbon monoxide detectors, and verified they were both functional. LPA toured the kitchen area and verified knives and cleaners were inaccessible to children in care. LPA observed a restroom and verified that hazardous and toxic items were inaccessible to children in care. Report continues on 809-C.

SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: HAN, MARY	FACILITY NUMBER: 390314373
	VISIT DATE: 03/04/2022

NARRATIVE

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Facility representative, Mary Han stated there are no weapons in the home. There are no bodies of water on the premises. Outdoor play space is fenced. LPA observed living room area with age appropriate toys for children. LPA observed the backyard was accessible to the children with appropriate play equipment available for the children. LPA did observe an unlocked shed in the backyard that contained chemicals and poisons. That could be accessible to children in care.

LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://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.

In addition, LPA discussed the infant sleep regulations with licensee. LPA discussed the requirement to check and log infant napping every 15 minutes / observed 15min infant napping logs for infants 24 months and under. LPA observed / provided a copy of LIC 9227 Individual Sleeping Plan, for infants under 12 months, for licensee during today's inspection.

Children's files were reviewed. Emergency information and required immunization records were on file. LPA observed a current roster. Facility representative, Mary Han, was unable to provide a fire drill log stating a fire drill is conducted at least once every six months. Licensee's immunization records for measles (MMR), pertussis (Tdap), and the flu are available in the facility file. Current in-person EMSA pediatric CPR and First Aid certification was verified and expires 8/2022 and Child Care Provider Mandated Reporter certification was expired in March 2021.

Report continues on 809-C.

SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

LIC809 (FAS) - (06/04)

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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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: HAN, MARY	FACILITY NUMBER: 390314373
	VISIT DATE: 03/04/2022

NARRATIVE

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LPA verified the annual fees are current.

This provider is not currently providing IMS services to children in care. Incidental Medical Services (IMS) policy was discussed.

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 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)/ (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/inspection-process

Exit interview conducted and report was reviewed with the facility representative. A Notice of Site Visit was given and must remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for childcare updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. facility representatives signature on this form acknowledges receipt of this form. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Report continues on 809-C.

SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

LIC809 (FAS) - (06/04)

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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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: HAN, MARY	FACILITY NUMBER: 390314373
	VISIT DATE: 03/04/2022

NARRATIVE

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LPA Scott informed facility representative, Loreen Gonzales, that this report, dated March 4, 2022, documents one Type A citation. Type A citation which shall be posted for 30 consecutive days as there is/are immediate risks to the health, safety, or personal rights of children in care.

Also, LPA Scott informed the licensee to provide a copy of this licensing report, dated March 4, 2022, that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit must remain posted for 30 days.

SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/04/2022 03:21 PM - It Cannot Be Edited

Created By: Lauren Scott On 03/04/2022 at 02:39 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: HAN, MARY	FACILITY NUMBER: 390314373
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102417(g)(4)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. LPA observed the abckyard shed was no secured with a lock and key. Inside the shed was chemicals and poisons, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/04/2022
	Plan of Correction
1 2 3 4

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Justin L Denton

LICENSING EVALUATOR NAME:

Lauren Scott

LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

LIC809 (FAS) - (06/04)

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