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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009709
Report Date: 02/22/2023
Date Signed: 02/22/2023 03:06:55 PM

Document Has Been Signed on 02/22/2023 03:06 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:HUFF, TANISHA FCCHFACILITY NUMBER:
483009709
ADMINISTRATOR:HUFF, TANISHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 980-6938
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 8DATE:
02/22/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Tanisha Huff - LicenseeTIME COMPLETED:
03:20 PM
NARRATIVE
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Licensing Program Analyst (LPA), Melchisedeck Augustin conducted a Case Management- Legal/Non-Compliance visit and met with Licensee, Tanisha Huff (LS) for the purpose of determining the facility's compliance with the Department's Stipulation Waiver and Order which became effective on 09/11/20. The facility is currently on Probation until 09/11/23 and the terms and conditions of the waiver are as follow:

A. Respondent shall operate the facility in strict compliance with the regulations and statutes governing the operation of a family child care home. During the period of probation, the Department in its sole discretion.

B. may conduct unannounced site visits for the purpose of determining whether there is full compliance with the regulations and statutes governing the operation of a family child care home.

C. Respondent shall ensure that all individuals working, residing or volunteering in the facility shall obtain criminal record clearances or exemptions prior to their initial presence in the facility and shall maintain proof of such criminal record clearances or exemptions at the facility.

D. Respondent shall comply with all exclusion orders issued by the
Department including the exclusion order issued against A1 on November 19, 2019.

E. This Stipulation shall be posted in a conspicuous place at the
facility for the duration of the probationary period.

(Continue to LIC 809-C)
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: HUFF, TANISHA FCCH
FACILITY NUMBER: 483009709
VISIT DATE: 02/22/2023
NARRATIVE
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F. Respondent shall report to the Licensing office the following: any
unusual incident including, but not limited to, client death or injury which requires medical treatment, any suspected physical or psychological abuse of any client, any physical plant changes and all unexplained absences. These incidents must be reported by the next working day, and a written report of the incident must be submitted within seven days following the occurrence of the incident.

G. For the duration of the probationary period, Respondent shall inform all current and prospective parents of children in the facility of the facility's probationary license by providing to the parents a copy of this Stipulation and the attached Accusation. Parents shall sign an acknowledgment indicating they have received a copy of the Stipulation and the attached Accusation. This parental acknowledgement shall be maintained in the corresponding child's file and shall be made available to the Department upon request.

H. Respondent shall, within 60 days of the adoption of this Stipulation, complete two (2) courses of training related to the allegations contained in the Accusation and approved by licensing. The training topics shall be as follows: 1) Adverse childhood experiences; 2) Mandated reporter training. Within 30 days after completing this requirement, Respondent shall submit to the licensing office a copy of the certificate of completion.

I. Respondent shall, within 18 months of the adoption of this
Stipulation, complete two (2) courses of training related to the allegations contained in the Accusation and approved by licensing. Respondent shall register for the courses within 90 days of the adoption of this Stipulation. If a training is not available within 90 days, Respondent shall ask the licensing office for an extension. Proof of enrollment shall be available to licensing upon inspection. The training topics shall be as follows: 1) Socio-emotional training development provided by the
Children's Trust Fund Alliance at https://ctfalliance. org/preventing-child- neglect/#Training;

(Continue to LIC 809-C)
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: HUFF, TANISHA FCCH
FACILITY NUMBER: 483009709
VISIT DATE: 02/22/2023
NARRATIVE
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2) The Strengthening FamiliesT Protective Factors Framework
provided by Community Connection of Kern County at https://kern.org/cccc/for-
providers/workshops/. If a specific training is not available, Respondent shall coordinate with the local licensing office for approval of another program. Within 30 days after completing this requirement, Respondent shall submit to the licensing office a copy of the certificate of completion.

J. If after two (2) years, Respondent is in substantial compliance of all Title 22 regulations, Respondent may petition the local licensing office to terminate probation. The decision to terminate probation shall be at the discretion of the licensing office.

The off limit areas consist of one bedroom on the first floor and entire second floor, kitchen, garage, and backyard; and were made inaccessible by plastic doorknob covers and children's safety gate. The facility's operating hours are 4:00AM to 6:00PM, Monday–Saturday. Upon LPA's arrival at 9:44am, LS was not present and there were nine children in care with only one staff (S1). LS arrived shortly after after at 9:50am and LPA notified LS that the facility was operating out of ratio and the facility did not comply with the Stipulation's requirement under section "A". LPA observed the Stipulation Waiver and Order, as well as the Earthquake Preparedness Checklist (LIC 9148) were not posted. LPA did not see A1 on the premise, and LS stated A1 did not reside, work and had not visited the facility, and LS claimed she complied with the Exclusionary Order against A1 and the Stipulation's requirements in sections, "C & D". A review of staff records on 02/22/2023 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There is currently one adult living in the home. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The staircase case was barricaded with a safety gate and the fireplace did not appear to be utilized. The mini blind cords were inaccessible. LS stated the facility did not store any firearm(s) or other dangerous weapons on the premise. LPA did not observe any poison(s) and cleaning compounds were inaccessible. There was a functional smoke and carbon monoxide detectors, and fully charged fire extinguisher; rated at least 2A10BC. LS reported that no unusual incident(s) had occurred, and LS acknowledged and understood she was required to report unusual incident(s) in accordance with California Code of Regulations 102416.2. (Continue to LIC 809-C)
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: HUFF, TANISHA FCCH
FACILITY NUMBER: 483009709
VISIT DATE: 02/22/2023
NARRATIVE
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LS conducted an emergency disaster drill within the past six months and the last drill was documented on 01/17/23. On 03/30/21, LS respectively submitted certificates of completion for Introduction to Advserse Childhood Experiences (ACEs) and early Trauma, AB 1207 Mandated Reporter Training certificate, Professional Development Certificate, Social Connections, and Social and Emotional Competence of Children.

LS stated she provided parents with a full physical copy of the Stipulation Waiver and Order and Accusation, and parents signed an acknowledgement form (LIC 9224) which notified them of the Accusation. LPA reviewed five children's (C1-C5) records at 11:52am which includes records for two children (C1 &C2) that are under 24 months old, and records reviewed revealed C1-C5's record contained LIC 9224 signed by the parents, Immunization Records (IR), and evidence of 15 minute checks for C1 & C2, however; C1 & C2's IR were not transcribed onto the blue CDPH 286. LPA reviewed two staff (S1 & LS) records at 12:25pm, which revealed S1's record was missing required Immunization Record and evidence of negative TB clearance. The facility roster of the children in care was reviewed and appeared to be complete.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the licensee, Tanisha Huff. The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/22/2023 03:06 PM - It Cannot Be Edited


Created By: Melchisedeck Augustin On 02/22/2023 at 12:55 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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: HUFF, TANISHA FCCH
FACILITY NUMBER: 483009709

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/03/2023
Section Cited
CCR
102416.5(e)

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If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by: Based on LPA's observation of nine children in
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Licensee stated she would obtain consent to transport children and in the future, Licensee intends to take some of the children with her whenever she runs errands to ensure the facility did not operate out of ratio. Licensee stated she would produce a written statement detailing how she would comply with the CCR 102416.5.
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care with only S1 at 9:44am which confirmed the facility operated out of ratio. This poses a potential health, safety and/or personal rights risk to the children in care.
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Email: melchisedeck.augustin@dss.ca.gov
Fax: 707-588-5099
Type B
03/03/2023
Section Cited
CCR102418(h)(1)

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The family day care home shall record each pupil's immunization on the California School Immunization Record, PM 286 (6/95).

This requirement is not met as evidenced by: Based on children's records reviewed at 11:52am which revealed C1 & C2's Immunization Records were not transcribed
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Licensee stated she would transcribed C1 & C2's Immunization Records onto the CDPH 286 and Licensee would submit the transcribed CDPH 286 to the Department by 03/03/23 via mail, email or fax.
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onto the CDPH 286. This poses a potential health, safety and/or personal rights risk to the children in care.
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Email: melchisedeck.augustin@dss.ca.gov
Fax: 707-588-5099
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:Leslie Lepori
LICENSING EVALUATOR NAME:Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2023


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Document Has Been Signed on 02/22/2023 03:06 PM - It Cannot Be Edited


Created By: Melchisedeck Augustin On 02/22/2023 at 01:27 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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: HUFF, TANISHA FCCH
FACILITY NUMBER: 483009709

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/03/2023
Section Cited
CCR
102416.1(d)

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All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.

This requirement is not met as evidenced by: Based on staff (S1 & LS) records reviewed at
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Licensee stated she would ensure that S1 obtain the required immunization and evidence of negative TB clearance, and Licensee would submit the documents to the Department by 03/03/23 via mail, email or fax.
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12:25pm which revealed S1's record was missing required Immunization Record and evidence of negative TB clearance. This poses a potential health, safety and/or personal rights risk to the children in care.
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Email: melchisedeck.Augustin@dss.ca.gov
Fax: 707-588-5099
Type B
03/03/2023
Section Cited
HSC1596.8595

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Notwithstanding subdivision (b) of Section 1596.859, the licensee shall post a licensing report or other appropriate document verifying the licensee’s compliance or noncompliance with the department’s order to correct a deficiency that is subject to posting pursuant to paragraph (1) of subdivision (a). The licensing report or other document shall be posted immediately upon receipt, adjacent to the posting required pursuant to Section 1596.817, on, or immediately adjacent to, the
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Licensee stated she did not know she was required to post the Stipulation Waiver and Order, and Earthquake Preparedness Checklist (LIC 9148), and Licensee posted the order on the parent board. Licensee also stated she would produce a written statement detailing how she would comply with posting requirements.
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interior side of the main door into the facility and shall be posted for a period of 30 consecutive days.
This requirement is not met as evidenced by: Based on LPA's observation of the Stipulation Waiver and Order was not posted as required by the Stipulation. This poses a potential health, safety and/or personal rights risk to the children in care.
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Email: melchisedeck.Augustin@dss.ca.gov
Fax: 707-588-5099
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:Leslie Lepori
LICENSING EVALUATOR NAME:Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2023


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