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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573615541
Report Date: 12/19/2023
Date Signed: 12/19/2023 01:25:22 PM

Document Has Been Signed on 12/19/2023 01:25 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:DEERING, STEFANIEFACILITY NUMBER:
573615541
ADMINISTRATOR:DEERING, STEFANIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 996-0863
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/19/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Stefanie DeeringTIME COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Erwin Tjhia met with licensee, Stefannie Deering for an unannounced Case Management inspection. There were no children and staff present during today's visit.

The purpose of the inspection was to follow up on an unusual incident that occurred on 10/25/23; which was self-reported to the Department by the facility. Throughout the investigation, LPA conducted interviews, and obtained pertinent information.

LPA learned that Child #1 engaged in inappropriate play with Child #2. After being told by Child#2 to stop, Child#1 continued the inappropriate play with other children on 10/25/2023. At least one of the children reported that they did not feel comfortable with these interactions by Child#1; therefore, the personal rights of children to be accorded dignity in their personal relationships with other persons were violated and a Type A deficiency is cited on the subsequent page 809-D. Upon receipt of Type A citations, the facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's files.

An Exit Interview was conducted in which the report was reviewed and discussed with licensee.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2023
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 12/19/2023 01:25 PM - It Cannot Be Edited


Created By: Erwin Tjhia On 12/19/2023 at 01:13 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DEERING, STEFANIE
FACILITY NUMBER: 573615541

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
12/20/2023
Section Cited
CCR
10243(a)(1)

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10243 Personal Rights (a) Each child receiving services... shall have certain rights that shall not be waived ... These rights include, but are not limited to, the following:
(1)To be treated with dignity in his/her personal relationship with staff and other persons.
This requirement was not met as evidenced by:
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Licensee shall submit a written plan outlining steps she is taking to ensure that the personal rights of all children is being ensured, and that the environment is safe and comfortable for all children at the facility.
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Child#2 reported that they were not comfortable with Child#1 inappropriately play with Child#2 and other daycare children on 10/25/2023.
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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:Bettina Engelman
LICENSING EVALUATOR NAME:Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2023


LIC809 (FAS) - (06/04)
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