102423(a)(2) · Personal Rights 102423 (a)Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee... (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment Per licensee, they will provided LPA J. Culbert with a declaration stating that they will remove all accessible hazards from on limits areas in the home and email declaration to LPA J. Culbert by plan of correction date.

Based on interview, the licensee left child 1 alone in bedroom with accessible glass. This is an immediate safety and personal rights risk to persons in care. Warren Birks NAME OF LICENSING PROGRAM MANAGER: Jonnisha Culbert NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/21/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

102425(a) · 102425 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. This requirment was not met as evidence by Per licensee, they will provide LPA a declaration stating that if they have knowledge of a child climbing out of the crib, they will no longer place that child in a crib. Per licensee, they will email signed declaration to LPA J. Culbert by plan of correction date.

Based on interview,the licensee did not comply with the section cited above. Per licensee, child 1 was placed in the crib. However, licensee and staff were aware that child 1 can climb out of the crib. This is a potential safety risk to persons in care

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

102416.2(a)(3)(C) · Reporting Requirements 102416.2 (a)(3)(c) The licensee shall report the following information the Department by telephone or fax within the Department's next business ...(C)Any unusual incident..

Per licensee, they will complete an unusual incident report form and email it to LPA J. Culbert by

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

102421(a)(b)(d) · 102421 (a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7). During record review, LPA observed that child 12's file was missing. Per licensee, they will obtains child 12's information and email it to LPA by plan of correction date. required in Section 102417(g)(7). (d) In any case in which the licensee cares for an additional... for a Small Family Child Care Home or Section 102416.5(d) for a Large Family Child Care Home, the licensee shall maintain..

Observed Child 12 missing file Warren Birks NAME OF LICENSING PROGRAM MANAGER: Jonnisha Culbert NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/12/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received.

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

102417(g)(9)(A) · Operation of A Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above. Per Licensee, a disaster drill has not been conducted since 10/2023 which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 07/24/2024

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

102423(a)(2) · 102423 Personal Rights (a) Each child receiving services from a family child care home shall have certain rights ...include, but are not limited to, the following: (2) To receive safe.. and comfortable accommodations... This regulation was not met as evidenced by Licensee states she will be at the curb no matter what it takes, though Licensee states Rec Aides assist in pick ups and work in parternship with her to ensure child enters her vehicle safely. Declaration was provided by Licensee. Clearing deficiency on this date. Based on LPA intervews, Licensee did not meet above regulation as multiple interviews disclosed that Licensee does not pull over and park during pick up to allow for child to enter vehicle safely. This poses a potential health, safety, and personal rights risk to children in care.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

102423(a)(4) · Personal Rights 102423(a)(4). To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, Licensee was reminded of protocols regarding adminitration of medication, parental and/or guardian consent to administer medication, and personal rights. Per Licensee, melatonin will not be given to any children in care. clothing, medication or aids to physical functioning.

Based on supportive documents and interviews, Licensee had melatonin administered to a child without consent for the purpose of the child taking a nap.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

102370(d)(1) · Criminal Record Clearance 102370(d)(1). All individuals subject to a criminal record review... shall prior to working, residing, or volunteering in a licensed facility (1) Obtain a California clearance or a criminal record exemption as required by the Department.

Hired personnel will not be present at the facility or assist with providing child care until the required clearances and/or exemptions are granted. Civil penatly for violation was assessed. Based on supporting documentation and confidental interviews, staff (S1) and staff (S2) worked at the facility prior to obtaining the required criminal record clearances and/or exemptions, which poses an immediate health and safety risk to persons in care.

Open Not marked corrected in the state record

Category: background checks. Open / not marked corrected.

102425(e) · Infant Safe Sleep 102425(e). No infant shall be forced to sleep, to stay awake, or to stay in the designated sleeping area. Licensee went into the nap area to get the infant. Licensee was also advised of the violation of the children's personal rights.

Based on observations and interview, a child was left unattended crying in the nap area and a child was told by Licensee you need to lay down which poses an immediate personal rights risk to persons in care. SUPERVISOR'S NAME: Valarie Cook

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

102417(g)(4) · Operation of a Family Child Care Home 102417(g)(4). Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. Licensee and Licensee's Assistant had immediately removed the clearning products and placed them in an area that is inaccessible to children in care. Licensee will provide training to all staff on the violation to prevent cleaning compounds being accessible to children.

LPAs observed a cleaning product accessible to children in care on top of the kitchen counter, and on top of a table in the outdoor patio while children were present, which poses a potential risk to persons in care. Licensee will submit any training material that was presented to staff and a sign-in sheet for attendees to LPA via e-mail by 03/15/2023. SUPERVISOR'S NAME: Valarie Cook

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

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, the licensee did not comply with the section cited above in 2 out of 5 children's records (C2 and C3) which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 03/03/2023

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.