102425(c)(1) · 102425(c)(1) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file. (1) This plan shall be signed and dated by the infant's authorized representative. Licensee agrees to agrees to have infant's authorized representative complete, sign and date LIC9227. Once LIC 9227 is complete Licensee will place in infant's file.

based on file review and interview with licensee. Infant's file was missing LIC 9227. If not corrected, this poses a potential risk to the children in care SUPERVISOR'S NAME: Peter Flores

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

102425(j)(1)(2)(D) · 102425(j)(1)(2)(D)Infant Safe Sleep The provider shall supervise infants while they are sleeping and adhere to the following requirements:(1) The provider shall physically check on the infant every 15 minutes. (2)The provider shall check and document the following:(D)Documentation shall be maintained in the infant’s file.... Licensee agrees to document and log infants sleep which will include all required information and maintained in theinfant's file. Licensee will read PIN 20-24-CCP and write a statement of understanding and provide to LPA by POC date by email, fax or mail.

based on file review, licensee failed to provide documentation regarding safe sleep. If not corrected, this poses a potential risk to the children in care