<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313621439
Report Date: 05/12/2023
Date Signed: 05/12/2023 01:47:21 PM

Document Has Been Signed on 05/12/2023 01:47 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:KENDRICK, NATALIEFACILITY NUMBER:
313621439
ADMINISTRATOR:KENDRICK, NATALIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 226-0200
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
05/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Natalie KendrickTIME COMPLETED:
01:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On May 12th, 2023, Licensing Program Analyst (LPA) Jeremey McClain met with licensee Natalie Kendrick for an unannounced Case Management Inspection.

Upon arrival, LPA observed nine children, supervised by three staff members.

On March 3, 2023, an unusual incident report was submitted to the Regional Office regarding an incident that occurred on the same day. Licensee reported that an 11-mo. infant was sitting at the table when a cup of coffee was spilled. The child sustained second degree burns from the hot liquid.

The incident was investigated by the Departments Investigations Branch (IB) with the incident determined to be substantiated. The department is issuing a Type A citation regarding the Personal Rights violation and an Enhanced Civil Penalty of $2,000 regarding the serious injury to the infant.

LPA Jeremey McClain informed facility representative, Natalie Kendrick, that this report dated May 12th, 2023, documents 1 Type A citation which shall be posted for 30 consecutive days as there was immediate risk to the health, safety, or personal rights of children in care.
Also, LPA Jeremey McClain informed the licensee, Natalie Kendrick, to provide a copy of this licensing report dated May 12th, 2023, that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
Posting Requirements
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted with licensee Natalie Kendrick and appeal rights were provided.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 05/12/2023 01:47 PM - It Cannot Be Edited


Created By: Jeremey McClain On 05/12/2023 at 01:15 PM
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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: KENDRICK, NATALIE
FACILITY NUMBER: 313621439

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/12/2023
Section Cited
CCR
102423(a)(2)

1
2
3
4
5
6
7
Personal Rights. (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 regardless of consent or authorization from the child's authorized representative. These rights include,
1
2
3
4
5
6
7
Licensee has excluded hot drinks in the presence of children in care. Licensee has rearranged the activity area and surveyed for hazards. Licensee discussed safety protocols with assistants and children in care.
8
9
10
11
12
13
14
but are not limited to, the following: ...(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This was requirement was not met, as evidenced by Licensee's self report that an 11 month old infant suffered second degree burns when a cup of hot coffee spilled on them while they were sitting at the table.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Keven Peters
LICENSING EVALUATOR NAME:Jeremey McClain
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2