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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009424
Report Date: 02/28/2024
Date Signed: 02/28/2024 02:20:51 PM

Document Has Been Signed on 02/28/2024 02:20 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:GRAY-MCDANIELS, CARLA FCCHFACILITY NUMBER:
483009424
ADMINISTRATOR:CARLA GRAY-MCDANIELSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 425-4057
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/28/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:27 PM
MET WITH:Licensee Carla Gray- McDanielsTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analysts ( LPAs) Elpidia Hernandez Torres and Melchsideck Augustin arrived to the facility to issue deficiency and to confirm no continued child care operations following the Temporary Suspension Order issued on 02/02/2024. Upon LPAs arrival, there were no children observed in the facility and the TSO was still posted on the front door.

During the course of investigation, LPA Elpidia Hernandez Torres observed an uncleared adult (A1) present in the facility providing care and supervision to children. LPA Hernandez Torres was present in the facility on 01/09/2024 conducting an inspection of the facility in which the Licensee reported A1 was a guardian to three children in care (C1-C3) and was volunteering. On 02/01/2024, LPA Hernandez Torres spoke to A2 via telephone and A2 identified themselves as the guardian of C1-C3 and reported they had never volunteered at the day care and was not present in the day care on 01/09/2024; and never met LPA Hernandez Torres. Children interviews revealed A1 was a staff member at the day care. Interview with another adult (A3) revealed A1 had been an employee at the daycare since about September of 2023. Two other adults (A4-A5) corroborated A1 was a staff member at the daycare. The following deficiency 102370(d)(1) is cited on LIC 809-D and $500 civil penalty is being assessed because the Licensee did not comply with requirements of criminal record clearance.

This report was reviewed with licensee and was provided with a copy and appeal rights.

This report dated 02/28/2024 document(s) one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPAs informed the licensee to provide a copy of this licensing report and Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/ guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2024
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 02/28/2024 02:20 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 02/28/2024 at 10:06 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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: GRAY-MCDANIELS, CARLA FCCH
FACILITY NUMBER: 483009424

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/29/2024
Section Cited
CCR
102370(d)(1)

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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record exemption as required by the Department
This was not met as evidence by. . .
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Licensee reported in the future once she receives the letter in the mail saying they were approved. I will make their appointment for fingerprints and when I receive the letter they can work.
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Based on LPAs observation on 01/09/2024, and interviews conducted Adult (A1) had been a staff of the licensee and did not have background clearance. CP of $500 is being issued. This poses an immediate health and safety risk to children in care.
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Licensee agreed to submit written statement and POC via email, mail or FAX to LPA Hernandez Torres by 02/29/24.

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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:Leslie Lepori
LICENSING EVALUATOR NAME:Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2024


LIC809 (FAS) - (06/04)
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