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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408426
Report Date: 11/09/2021
Date Signed: 11/09/2021 11:32:17 AM

Document Has Been Signed on 11/09/2021 11:32 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:TAGHOUTI, JUNEFACILITY NUMBER:
073408426
ADMINISTRATOR:TAGHOUTI, JUNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 313-4603
CITY:HERCULESSTATE: CAZIP CODE:
94547
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 11DATE:
11/09/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:June TaghoutiTIME COMPLETED:
11:45 AM
NARRATIVE
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On 11/9/21 at 9:00 AM Licensing Program Analyst (LPA) Monica Mathur and Ashley Curry conducted an unannounced Case Management inspection at June Taghouti's family day care for a self reported incident of a child who walked away from the day care.

It was determined that on 10/27/21 a child (C1) came back inside the home from outdoor play yard while Helper ANDREA was assisting other children to come in. Licensee mistakenly left the front door open, was in the garage and heard child footsteps walking toward the front door. She knew the door was open and immediately ran out the garage side door to find C1 on the sidewalk within a few seconds and almost immediately. The licensee was able to reach the child right away. Since the incident a spring hinge has been installed on the main door that self closes and automatically locks the door.

It was determined that Helper ANDREA a new hire was on her second day of work on 10/27/21, day of incident. Licensee states ANDREA started work on 10/25/21 and provided supervision and care to children on her first day. Licensee states she uploaded a transfer request on Guardian in the early morning of 10/27/21, assumed transfer was immediate but did not verify if fingerprints were associated to license that day. She states she has not been able to log on to her account in Guardian and has been facing difficulties with it. ANDREA has eligible clearance. Civil penalty is assessed for 1 day ($100)

At 11:150 AM exit interview was conducted with Licensee June. This report was reviewed and a Notice of Site Visit was issued.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2021
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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Document Has Been Signed on 11/09/2021 11:32 AM - It Cannot Be Edited


Created By: Monica Mathur On 11/09/2021 at 10:39 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: TAGHOUTI, JUNE
FACILITY NUMBER: 073408426

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/12/2021
Section Cited
CCR
102417(a)

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102417 Operation of a Family Child Home (a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times [...]. This requirement is not met as evidenced by:
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By POC Due Date 11/12/21 Licensee agreed to hold all staff training, discuss plan of supervision and watch training video on CCLD site
www.ccld.ca.gov.
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Per investigation, C1 was found unattended on the sidewalk outside the main door. Licensee reached child immediately within seconds. This posed a potential risk to safety of child in care.
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Licensee to submit a statement confirming training was held.
Type B
11/12/2021
Section Cited
CCR102370(d)(2)

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102370 Criminal Record Clearance (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility
(2) Request a transfer of a criminal record clearance. This requirement is not met as evidenced by:
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By POC Due Date Licensee to submit written statement of her understanding and plan of how to associate fingerprints moving forward.
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Per review of records Helper ANDREA fingerprints were not transferred prior to her providing care to children. Licensee uploaded transfer request but could not access Guardian account and did not verify association. This posed a potential risk. Civil penalty assessed for 1 day for $100.
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ANDREA is associated and has eligible clearance as of 11/5/21.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sherelle Johnson
LICENSING EVALUATOR NAME:Monica Mathur
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2021


LIC809 (FAS) - (06/04)
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