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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503809868
Report Date: 12/20/2022
Date Signed: 12/20/2022 10:21:35 AM

Document Has Been Signed on 12/20/2022 10:21 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:WILLIAMS, STEPHANIE FAMILY CHILD CAREFACILITY NUMBER:
503809868
ADMINISTRATOR:WILLIAMS, STEPHANIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 277-7920
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/20/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Stephanie Williams TIME COMPLETED:
10:30 AM
NARRATIVE
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On 12/20/2022, Licensing Program Analyst (LPA) Araceli Gibson and (LPA) Joe Pacheco conducted an unannounced case management inspection. LPA's met with licensee Stephanie Williams. A tour of the home and a census was taken.

On 08/09/22, LPA Gibson was unable to verify LIcensee or Assistant had verification of immunizations TDAP or MMR. On that date, LPA Gibson issued a citation 1597.622(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

On that date LPA Gibson also issued a citation for Assistant not completing the Mandated Reporters Training for Childcare Providers (AB1207) 1596.8662(b)(1).

Training has not been completed and will not be accepted in another person's name. Furthermore, Licensee understands that, Licensee must still maintain a complete file on site for all staff and for herself as the Licensee. LPA Gibson provided many extensions, last one extension with a due date of 11/4/2022.

Based on not receiving evidence to clear these deficiencies. LPA Gibson is reissuing the citations. Failure to comply or submit evidence of these records by the plan of correction date Licensee will be requested to attend an informal meeting with CCLD administrators for possible further action.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2022
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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Document Has Been Signed on 12/20/2022 10:21 AM - It Cannot Be Edited


Created By: Araceli Gibson On 12/19/2022 at 06:55 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
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: WILLIAMS, STEPHANIE FAMILY CHILD CARE
FACILITY NUMBER: 503809868

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/02/2023
Section Cited
HSC
1597.622(c)

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(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
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Licensee agrees to submit evidence of immunizations for herself and assistant by 01/02/23. Failure to comply or submit evidence of these records by the plan of correction date Licensee will be requested to attend an informal meeting with CCLD administrators for possible further action.
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Based on record review, the licensee did not comply with the section cited above Licensee and assistant were unable to provide evidence of required immunizations TDAP, or MMR. which poses a potential health, safety or personal rights risk to persons in care.
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Type B
01/02/2023
Section Cited
HSC1596.8662(b)(1)

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(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.
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Licensee agrees to provide evidence of completed Mandated Provider Training AB1207 for assistant. Failure to comply or submit evidence of these records by the plan of correction date Licensee will be requested to attend an informal meeting with CCLD administrators for possible further action.
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This requirement is not met as evidenced by:Based on record review the licensee did not comply with the section cited above. Assistant was not able to provided evidence of Mandated Provider Training AB1207 at the time of the inspection, which poses a potential health, 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:Juvenal Moctezuma
LICENSING EVALUATOR NAME:Araceli Gibson
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2022


LIC809 (FAS) - (06/04)
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