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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010018
Report Date: 11/14/2022
Date Signed: 11/14/2022 04:33:33 PM

Document Has Been Signed on 11/14/2022 04:33 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:DURGIN, DEBRA FCCHFACILITY NUMBER:
493010018
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 3DATE:
11/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:02 PM
MET WITH:Debra DurginTIME COMPLETED:
04:18 PM
NARRATIVE
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An unannounced case management visit to the facility was made today by Licensing Program Analyst (LPA), Y. Yang in response to a self reported absence of supervision incident that occurred at the facility on 11/01/22 involving child C1. Previously, an attempted visit was made by the LPA on 11/08/22. During today's case management visit, the licensee and an assistant were supervising three children. It was reported by the Licensee, Debra Durgin, that on 11/01/22 at approximately 12:00pm, child C1 wandered away from her and her assistant (staff S2) during a nature walk to a park located down the street from the facility. The Licensee stated that child C1, who normally rides in a stroller, was walking and “puddle jumping” with the rest of the children in the group. The Licensee stated that there was a total of five preschool age children at the time being supervised by her and staff S2. The Licensee stated that she was walking with three of the children and staff S2 was following behind and walking with the remaining two. The Licensee stated that due to a miscommunication between her and staff S2, both staff members believed the other was supervising child C1. The Licensee stated that child C1 wandered away from the group without her or staff S2 noticing during their walk.

The Licensee stated that she estimates daycare child C1 was without the supervision of a staff member for approximately 15 minutes before law enforcement was contacted by a member of the public. The licensee stated that while walking back to the facility, they approached the law enforcement officer and was asked by the officer if they were missing a child. The licensee stated that her and staff S2 initially informed the officer that they were not missing a child as they believed all five children in their possession were accounted for. The Licensee stated that the officer then asked her to identify a child in their possession. The licensee stated that the child in the officer’s possession was child C1. The licensee stated that the child was unharmed, and the child’s authorized representative was notified of the incident immediately.

Continued on LIC809-C
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2022
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 11/14/2022 04:33 PM - It Cannot Be Edited


Created By: Yang Yang On 11/14/2022 at 02:35 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: DURGIN, DEBRA FCCH
FACILITY NUMBER: 493010018

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/15/2022
Section Cited
HSC
1597.58(c)(2)

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Absence of supervision, including, but not limited to, a child left unattended and a child left alone with a person under 18 years of age. This requirement is not met as evidenced by:
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This deficiency was cleared during today's case management visit. The licensee submitted a written plan of correction indicating the immediate actions the facility has taken and the steps it will take moving forward to address supervision at the facility. The licensee stated that the facility will maintain a ratio of 1 staff to three children. In addition, the licensee stated that she has also purchased fluorescent yellow t shirts for the children to wear on outings with the facility's name and contact information printed on them.
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Based on the licensee's own admission on 11/01/22 and 11/14/22, child C1 was left without staff supervision for approximately 15 minutes while on a group walk outside of the facility on 11/01/22. This posed an immediate health and safety risk to the child(ren) in care.
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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:Alexis Hollon
LICENSING EVALUATOR NAME:Yang Yang
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2022


LIC809 (FAS) - (06/04)
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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: DURGIN, DEBRA FCCH
FACILITY NUMBER: 493010018
VISIT DATE: 11/14/2022
NARRATIVE
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The licensee notified the LPA and CCLD by telephone on the day of the incident and a written Unusual Incident Report (UIR) by was received by the Department on 11/01/2022. The licensee stated that as a result of this incident, the facility has implemented some changes to its operating procedures. The license stated that the facility now utilizes a staff to child ratio of 1:3 or fewer. The licensee stated that on all outings outside of the facility, there are now three staff members supervising the children. The licensee stated that she has also purchased customized fluorescent yellow t-shirts with the facility’s contact information for the children to wear on outings.

California Code of Regulations, Title 22, is being cited on the attached LIC 9099-D. A civil penalty is being assessed. An exit interview was conducted, and this report was read and discussed with the facility’s licensee, Debra Durgin. Appeal rights were provided. The Notice of Site Visit shall be posted for 30 days.

Reports citing Type A violations are to be provided to parents/guardians of children currently enrolled by the next business day or the next day the children are in care, and to parents/guardians of children newly enrolled at the facility for the next 12 months from the date of this report. Parents/guardians must sign Form LIC 9224 to be kept in each child's file.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
LIC809 (FAS) - (06/04)
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