Savage, Linda

102417(m)(3) · (3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state. Licensee will obtain Affidavit regarding Liability Insurance LIC282 from parents of Child #4- Child #5 and provide copy to LPA Calderon by poc due date.

On 11/13/25 Child #4 and Child #5 still missing form- Affidavit regarding Liability Insurance LIC282 Warren Birks NAME OF LICENSING PROGRAM MANAGER: Ashley Calderon NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/13/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received.

View state record

102425(a)(3) · Infant Safe Sleep (a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (3) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.

Deficient Practice Statement Based on observation by LPA Calderon play yard did not have a firm mattress and fitted sheets, the licensee did not comply with the section cited above in [1] out of [1] play yard for infant which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 06/16/2025

View state record

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.

Deficient Practice Statement Based on record review Licensee was not able to provide a Pediatric 1st aid and cpr and Staff assistant 1st aid and cpr expired 1/17/25, the licensee did not comply with the section cited above in [2] out of [2] Pediatric 1st aid and cpr certificates which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 06/16/2025

View state record

102418(a) · Immunizations (a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

Deficient Practice Statement Based on record review Child #1 and Child #2 did not have immunization records in file, the licensee did not comply with the section cited above in [2] out of [5] immunization records for children which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 06/16/2025

View state record

102419(d) · Admission Procedures and Parental and Authorized Representative's Rights (d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).

Deficient Practice Statement Based on record review LPA Calderon did not see Child #1 ,Child #2 and Child #3 reciept of Parnet Rights- LIC955 in file, the licensee did not comply with the section cited above in [3] out of [5] Parnet Rights- LIC955 in file for children which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 06/16/2025

View state record

102421(b) · Child's Records (b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7).

Deficient Practice Statement Based on record review Child #1 and Child #2 do not have a file Emergency Information LIC700 and LIC627 Consent for medical treatment form was not provided to LPA Calderon, the licensee did not comply with the section cited above in [2] out of [5] Child records regarding Emergency Info form which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 06/16/2025

View state record

102417(m)(3) · Operation of A Family Child Care Home (3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

Deficient Practice Statement Based on record review affidavit regarding Liability Insurance LIC282 Child #1- Child #5 files did not have form in place, the licensee did not comply with the section cited above in [5] out of 5] children file which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 06/16/2025

View state record

102425(j)(2)(D)(c) · Infant Safe Sleep Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

Deficient Practice Statement Based on record review Child #1 is an infant and did not have a 15 min sleep log, the licensee did not comply with the section cited above in [1] out of [1] infant which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 06/16/2025

View state record

102391(d) · Inspection Authority of the Department (d) The licensee shall permit the Department to inspect, audit, and copy children's records or other family child care home records upon demand during normal business hours. Records may be removed if necessary for copying.

Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above. During children's file review, LPA did not observe child #3 file. Licensee stated child #3 is missing a file. This poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 05/25/2023

View state record

102416.1(a) · Personnel Records (a) Personnel records shall be maintained on each employee and shall contain the following information

Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above. During file review, LPA did not observe a file for assistant. Per Licensee state that she has not created a file for assistant. This poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 06/05/2023

View state record