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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408641
Report Date: 08/24/2023
Date Signed: 08/24/2023 11:33:40 AM

Document Has Been Signed on 08/24/2023 11:33 AM - 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ROEMER-MAGGANAS, KARENFACILITY NUMBER:
073408641
ADMINISTRATOR:ROEMER-MAGGANAS, KARENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 219-6211
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 9DATE:
08/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Karen Roemer-MagganasTIME COMPLETED:
12:00 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 8/24/23 Licensing Program Analyst (LPA) Monica Mathur conducted an Unannounced Case Management inspection at Karen Roemer-Magannas's family childcare home. LPA met with Licensee, Karen and explained purpose of today's inspection. Present in the home were Licensee, 1 Assistant and 9 day care children (1 infant, 8 preschool age). Facility is in ratio compliance and all adults have background clearances.

Purpose of today's inspection is to verify corrections made for technical violations issued during an unannounced required inspection on 7/21/23. LPA reviewed personnel and children files.
- Mandated Reporter training: is completed. Licensee's certificate expires 8/16/25 and Assistant's 8/21/25.
- Pediatric CPR & First Aid: Licensee and Assistant are registered to take class on 9/2/23. LPA verified proof of registration. Licensee agreed to submit proof of training completed to Licensing and keep a copy in personnel files.
- Infant Sleep Logs: verified in infant files
- MMR: Assistant's medical clinic approved a titer test on 8/7/23 however Assistant has not completed the lab work yet. Licensee agreed to submit proof and keep a copy in personnel files
- Child Immunizations: Licensee states some parents emailed records while others have not brought records to her yet. Licensee was having computer technical issues today. LPA could not verify Immunizations records for all 11 enrolled children today. Licensee agreed to submit proof and keep a copy in child files.
- Notification of Parents Rights LIC995A: children files did not have receipts/verifications. Licensee agreed to submit proof and keep a copy in child files.

Regulatory violations were observed today. Deficiencies are cited on 809-D page. Failure to submit corrections by POC due date 9/5/23 may result in repeat violation with civil penalty assessment. This report was reviewed with Licensee, Karen Roemer-Magganas. A NOTICE OF SITE VISIT WAS ISSUED, MUST BE POSTED NEAR ENTRANCE FOR 30 DAYS.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2023
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 3
Document Has Been Signed on 08/24/2023 11:33 AM - It Cannot Be Edited


Created By: Monica Mathur On 08/24/2023 at 10:31 AM
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
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ROEMER-MAGGANAS, KAREN
FACILITY NUMBER: 073408641

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/05/2023
Section Cited
HSC
1597.662(a)(1)

1
2
3
4
5
6
7
1597.662 Employees or volunteers at family day care home; immunization requirements; records; exemptions(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met.
1
2
3
4
5
6
7
By POC Due Date 9/5/23 Licensee agreed to submit Assistant's MMR verification to Licensing via email or mail.
8
9
10
11
12
13
14
Per file review, Assistant present today, working at the facility for several years does not have MMR verification on file. This poses a potential risk to health/safety of children in care.
8
9
10
11
12
13
14
Failure to submit corrections by POC due date may result in repeat violation with civil penalty assessment.
Type B
09/05/2023
Section Cited
CCR102418(g)

1
2
3
4
5
6
7
102418 Child Records (g) The licensee shall document each child's Immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met:
1
2
3
4
5
6
7
By POC Due Date 9/5/23 Licensee agreed to obtain immunization records for all 11 presently enrolled children and submit to Licensing via email or mail.
8
9
10
11
12
13
14
Per file review, child records do not have their immunizations verifications on file. This poses a potential risk to health/safety of children in care.
8
9
10
11
12
13
14
Failure to submit corrections by POC due date may result in repeat violation with civil penalty assessment.
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:Sherelle Johnson
LICENSING EVALUATOR NAME:Monica Mathur
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2023


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/24/2023 11:33 AM - It Cannot Be Edited


Created By: Monica Mathur On 08/24/2023 at 10:53 AM
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
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ROEMER-MAGGANAS, KAREN
FACILITY NUMBER: 073408641

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/05/2023
Section Cited
CCR
102419(d)(1)

1
2
3
4
5
6
7
102419 Admission Procedures and Parental and Authorized Representative's Rights (d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parents’ Rights, LIC 995A [...] (1)The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A. The bottom portion of this form must be kept in the child’s file. This requirement is not met.
1
2
3
4
5
6
7
By POC Due Date 9/5/23 Licensee agreed to obtain signed receipts from parents of all enrolled children form LIC995A. LPA provided a copy of the form to Licensee.
8
9
10
11
12
13
14
Per file review, all children records are missing Notification of Parents Rights form LIC995A. This poses a potential risk to health/safety of children in care.
8
9
10
11
12
13
14
Failure to submit corrections by POC due date may result in repeat violation with civil penalty assessment.

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:Sherelle Johnson
LICENSING EVALUATOR NAME:Monica Mathur
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2023


LIC809 (FAS) - (06/04)
Page: 3 of 3