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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500765
Report Date: 02/14/2024
Date Signed: 02/14/2024 11:55:43 AM

Document Has Been Signed on 02/14/2024 11:55 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CHERRY, STEPHANIEFACILITY NUMBER:
394500765
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
02/14/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Licensee, Stephanie CherryTIME COMPLETED:
12:15 PM
NARRATIVE
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On February 14, 2024, Licensing Program Analysts (LPA) Elizabeth Santiago met with Licensee Stephanie Cherry, for the purpose of an unannounced plan of correction inspection to clear a Type B deficiency, which was issued on 01/03/2024 for not having an emergency card for children in care, which poses a potential health, safety, or personal rights risk to persons in care.

During today's inspection LPA toured all areas accessible to children in care and observed 5 children present, four infants and one age 3 years old being supervised by the Licensee and her assistant, Allet. Licensee is currently operating over ratio, and Licensee will have parent pick up children. LPA informed Licensee that facility is currently operating over ratio which poses an immediate health, safety or personal rights risk to persons in care. Licensee understood.

Through children record review, LPA did not observe children files complete. 10 out 13 children files did not have a complete LIC9150, parent notification additional children in care. The following Title 22 Deficiency is being cited on the subsequent 809-D page.

Deficiency cited on 01/03/2024 is cleared effective today. Proof of correction letter was provided. Notice of Site Visit was posted. Appeal rights were discussed and provided to licensee. This report was reviewed and discussed with the Licensee.

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Elizabeth Santiago
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2024
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 02/14/2024 04:16 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/14/2024 04:07 PM


Created By: Elizabeth Santiago On 02/14/2024 at 11:27 AM
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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CHERRY, STEPHANIE
FACILITY NUMBER: 394500765

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/14/2024
Section Cited
CCR
102416.5(b)(1)

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102416.5(b)(1) Staffing Ratio and Capacity: (b)For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time,...shall be the following: (1) Four infants; This requirement is not met as evidenced by:
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Licensee called parent to pick up children.
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Based on record review, the licensee was over ratio; 4 infants in care and one child age 3 years old,which poses an
immediate health, safety or personal rights risk to persons in care.
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Type B
03/14/2024
Section Cited
CCR102421(d)(1)

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(d) In any case in which the licensee cares for an additional child… for a Small Family Child Care Home...(d)the licensee shall maintain, in the child's record, proof of parent notification that the facility is caring for an additional child ... This requirement is not met as evidenced by:
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Licensee will complete children files and have LIC9150 completed and send LPA proof by POC date.
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Based on record review, 10 out 13 children files did not have a complete LIC9150, parent notification additional children in care in children files, which posed a potential health and safety, or personal rights risk to persons 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:Chayntel Hunter
LICENSING EVALUATOR NAME:Elizabeth Santiago
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2024


LIC809 (FAS) - (06/04)
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