503809868-3-15-2023-04-CC-AGIN-CPXV6M-20230315160946

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503809868
Report Date: 02/01/2023
Date Signed: 03/15/2023 04:10:00 PM

Document Has Been Signed on 03/15/2023 04:10 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	WILLIAMS, STEPHANIE FAMILY CHILD CARE		FACILITY NUMBER:	503809868
ADMINISTRATOR:	WILLIAMS, STEPHANIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 277-7920
CITY:	TURLOCK	STATE: CA	ZIP CODE:	95382
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 9	DATE:	02/01/2023
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Stephanie Williams		TIME COMPLETED:	11:00 AM

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On 02/01/2023, an Informal Conference meeting was conducted today via Microsoft Teams meeting at the Fresno Regional Child Care Office. In attendance during this meeting was: Licensing Program Manager (LPM), Juvenal Moctezuma, Licensing Program Analyst (LPA), Araceli Gibson, and Licensee, Stephanie Williams and Spouse. The purpose of the informal conference is to discuss lack of compliance in adhering to California Health and Safety codes and Title 22 Licensing regulations, which resulted in deficiencies being cited. A one year required inspection was conducted on 08/09/2022. LPM Moctezuma reviewed and discussed the inspection and the expectations on how the Family Child Care Home will maintain compliance with the deficiencies cited below.

The Department of Social Services, Community Care Licensing Division has determined that Stephanie Williams Family Day Care Home violated the following Title 22 licensing regulations/California Health and Safety Codes:

TYPE B Citation for HSC 1596.8662(b)(1) issued on 08/09/22 and on 12/19/22. (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: Licensee did not have evidence of AB1207 Training on file. Licensee agrees to provide evidence of completed Mandated Provider Training AB1207 for assistant.

TYPE B Citation for HSC 1597.622(c) issued on 08/09/22 and on 12/19/22. (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: Licensee not having proof of required immunization. Licensee agrees obtain immunization record or documentation by a medical facility or licensed physician for medical exemption for herself and assistant.

These citations were issued twice and remain uncleared. Continue on 809C

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: WILLIAMS, STEPHANIE FAMILY CHILD CARE	FACILITY NUMBER: 503809868
	VISIT DATE: 02/01/2023

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One Type B citation regarding Safe Sleep regulations and two Technical Violations were issued on 08/09/2022.

On 08/09/22 – Type B- 102425(c)(2) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above Licensee did not have the LIC 9227 for infant in care. which poses a potential health, safety or personal rights risk to persons in care.

On 08/09/22 - Technical Violation 102425(j)(2) - The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: - Licensee had not been documenting sleeping for infant in care. Started the log and documented sleep on site.

On 08/09/22 - Technical Violation 102425(j)(5)(A)
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times. The provider shall be able to visually observe the infant without moving the door. - Licensee stated she was unaware of the regulation and had the door closed. LPA opened the door. LPA provided and advised licensee of the regulation.

Licensee has submitted proof of corrections for the above-mentioned citations, and the deficiency was cleared.

COMPLIANCE PLAN
In response to these discussions, Licensee has agreed to the following:
1. Licensee will ensure children are provided with a safe and healthful environment during operational hours.
2. Licensee will keep record of in her home and provide evidence of immunizations of Pertussis, Measles, FLU (optional) with a decline statement) for herself and qualified assistant by 02/15/2023.

CONTINUED ON 809-C

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: WILLIAMS, STEPHANIE FAMILY CHILD CARE	FACILITY NUMBER: 503809868
	VISIT DATE: 02/01/2023

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3. Licensee will provide evidence of having a qualified assistant complete with immunizations, and current Mandated Reporter Training for Child Care Providers AB1207 by 02/15/2023. Licensee is required to have an assistant when caring for more than 8 children or maintain capacity limits as specified on her license.
4. Licensee shall attend the Family Child Care Orientation at the Fresno Regional Office on Wednesday, February 15, 2023 8:30 a.m. – 1:00 p.m. and submit the certificate of completion to the Department by 02/15/23. This is to ensure that licensee is aware of Community Care Licensing Title 22 regulations regarding safe sleep documentation requirements, Safe Sleep Plan LIC 9227 and Safe Sleep regulations. Licensee to also gain understanding of payment of required annual fees, to operate her daycare and stay in compliance.

Licensee shall submit a written plan to Community Care Licensing Division and certificate of training attended by 2/15/23 indicating how she will comply with the above requirements. In addition, it was recommended that licensee connect with her local resource and referral agency for additional support and training.

Today, Licensee was informed that any further repeats of the above deficiencies will result in a Non-Compliance Conference and possible referral to the Legal Division for possible Administrative Action. Furthermore, Licensee understands that any repeats of the above deficiencies within a 12-month period will result in the issuance of civil penalties.

Upon receipt of this report, please provide copies of this licensing report to each parent/guardian of children currently enrolled and to parents/guardians of newly enrolled children during the next 12 months. Acknowledgement of Receipt LIC 9224 form shall be used for this purpose. LIC 9224 after completed shall be maintained in each child's file. LIC 9224 was provided to Licensee, Stephanie Williams.

A copy of this report was given to Licensee, Stephanie Williams. Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, No Deficiencies are cited during today’s Office Visit.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

LIC809 (FAS) - (06/04)

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