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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620786
Report Date: 06/27/2023
Date Signed: 06/27/2023 12:19:37 PM

Document Has Been Signed on 06/27/2023 12:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ARANT, AMYFACILITY NUMBER:
313620786
ADMINISTRATOR:AMY ARANTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 368-0500
CITY:APPLEGATESTATE: CAZIP CODE:
95703
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
06/27/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Amy ArantTIME COMPLETED:
12:25 PM
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At 10:55am on 6/27/2023, Licensing Program Analyst (LPA) Matthew Gallo met with licensee Amy Arant for the purpose of an unannounced case management visit. The visit is in regard to an unusual incident report (UIR), submitted on 6/9/2023, that details an incident on 6/8/2023 in which a child required medical attention after having ingested a plant in the outdoor play yard of the facility. 13 children were present during the inspection, composed of 1 infant, 6 preschool children, and 6 school aged children.

Through the UIR and interview with licensee and staff, LPA learned that upon becoming sick on the evening of 6/8/2023, the child reported to their mother that they had eaten "wild peas" from the licensee's yard. At the time of ingestion, the child along with the other children present had been under the supervision of two assistants. Neither saw the child eat the plant, and wild peas do not grow on the licensee's property. The child's symptoms included dilated pupils and nausea leading to vomiting. Child was taken to Urgent Care and provided IV fluids and remained under observation for several hours. After receiving the news from the child's parent, the licensee searched their yard and identified a "Scotch Broom" shrub that produces small seed pods. The shrub was on the other side of the outdoor play yard fence, but dangled through the gaps in the fence. Licensee subsequently looked up the plant online and discovered that it can indeed be toxic to ingest. Licensee was previously unaware of this information, and the plant has always grown wild on the property. As a precaution, licensee called all parents and informed them of the situation. No other children reported being ill. Licensee reports that they trimmed the shrub the following day, and LPA observed that it is now more than 5 feet away from the fence of the play yard. The child returned to daycare the day after the incident occurred.

LPA determined that the incident did not result in any violations of Title 22 regulations. An exit interview was conducted and a Notice of Site Visit and appeal rights were provided. The Notice of Site Visit shall remain posted for 30 days for guardian/parental review. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2023
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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