Admission Procedures and Authorized Representatives 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). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. The bottom portion of this form must be kept in the child’s file as proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver background Check Process, LIC 995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05). This requirement is not met as evidenced by: Based on record review, the facility did not comply with the section cited above by failing to provide child 5 LIC995A which posed a potential risk to the Health, Safety or Personal Rights risk to persons in care.
Correction / follow-up note
Admission Procedures and Authorized Representatives 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). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. The bottom portion of this form must be kept in the child’s file as proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver background Check Process, LIC 995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05). This requir...
Correction status
Plan of correction due by July 17, 2026
More details
Official CA class
Type B deficiency
Report section
CCR 102419(d)(1) - 102419(d)(1)
Official code
102419(d)(1)
Higher concern: Sleep safety
Report finding
Infant Safe Sleep 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 facility did not comply with the section cited above by failing to provide child 4 LIC9227 which posed a potential risk to the Health, Safety or Personal Rights risk to persons in care.
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). This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by failing to maintain copies of LIC 995A Notification of Parent's Rights for child #1, #2, #3, #4 and #5 which posed a potential Health, Safety or Personal Rights risk to persons in care.
Correction status
Plan of correction due by October 27, 2023
More details
Official CA class
Type B deficiency
Report section
CCR 102419(d) - 102419(d)
Official code
102419(d)
Low concern: Recordkeeping
Report finding
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). This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by failing to maintain copies of LIC 700 Identification and Emergency Information for child #1 and #2 which posed a potential Health, Safety or Personal Rights risk to persons in care.
Correction status
Plan of correction due by October 27, 2023
More details
Official CA class
Type B deficiency
Report section
CCR 102421(b) - 102421(b)
Official code
102421(b)
Medium concern: Recordkeeping
Report finding
Operation of A Family Child Care Home (7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by failing to maintain copies of LIC 627 Consent for Emergency Medical Treatment for child #1, #2, #3, #4, and #5 which posed a potential Health, Safety or Personal Rights risk to persons in care.
Correction status
Plan of correction due by October 27, 2023
More details
Official CA class
Type B deficiency
Report section
CCR 102417(g)(7) - 102417(g)(7)
Official code
102417(g)(7)
Low concern: Recordkeeping
Report finding
Operation of A Family Child Care Home (8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by failing to maintain a copy of the LIC9040 Facility Roster which posed a potential Health, Safety or Personal Rights risk to persons in care.