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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009709
Report Date: 03/08/2023
Date Signed: 03/08/2023 03:30:58 PM

Document Has Been Signed on 03/08/2023 03:30 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: 10DATE:
03/08/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:02 PM
MET WITH:Tanisha Huff - LicenseeTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA), Melchisedeck Augustin conducted a Plan of Correction (POC) visit and met with Licensee, Tanisha Huff (LS) for the purpose of following up on several type B deficiencies that were cited on 02/22/23. The facility was cited for operating out of ratio and for not transcribing C1 & C2's Immunization Record (IR) on the CDPH 286. Additionally, LS did not furnish evidence of negative TB clearance and proof of immunity against Measles, Pertussis, and Influenza for staff (S1).

On 02/23/23, LS submitted a written plan indicating she would produce and request for parents to sign a consent form to allow LS to transport childcare children, to prevent future incident(s) of operating out of ratio. Furthermore, upon LPA's arrival, LPA observed S1 alone caring for eight children that were napping in either on a cot or in a play yard in the playroom and family room area, and the facility was complying with ratio requirements. On 02/27/23, LS submitted evidence of negative TB clearance for S1 and proof of immunity against the Pertussis and Influenza. LPA reviewed two children's (C1 & C2) records at 2:25pm, which revealed C1 & C2's records contained Immunization Records that were transcribed onto the blue CDPH 286. LS did not furnish proof of immunity against the Measles which was due on 03/03/23 and LS requested an extension on her POC due date. The Department is extending the POC due dat,e and LS is required to submit her POC before the close of the Department's business day on 03/09/23, and LS understood if she did not submit her POC by the due date, the Department may assess Civil Penalty of $100 per day for not correcting the deficiency.

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. There were no violation(s) of the California Code of Regulations, Title 22 issued during this visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2023
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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