BLAIR, JENNIFER FCCH

Based on LPA observations at 10:02am of the Licensee's (LS) and S1-S2 requested records. L1 did not furnishing a current Mandated Reporter Training certification for S1-S2. Which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated S1 and S2 would complete Mandated Reported Training Certification on mandatedreporterca.com. Licensee will submit proof to the department of Mandated Reporter Training certificates for S1 and S2 by 10/04/24 via mail, email or fax. Email: cindy.castro@dss.ca.gov & Fax: 707-588-5099

Licensee did not furnishing a current EMSA approved Pediatric CPR/First Aid certification for S1 and S2. L1 did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated S1 and S2 would enroll in an EMSA approved Pediatric CPR/First Aid training, complete the training and submit a copy of staffs current certification to the Department by 10/11/24 via mail, email or fax. Email: cindy.castro@dss.ca.gov & Fax: 707-588-5099

Based on LPA Staff Records reviewed at 10:02am Licensee did not furnish records for S1 or S2, which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she would produce personnel record for S1 and S2. Licensee will submit proof of complete staff files for S1 and S2 to the department by 10/11/24 via mail, email or fax. Email: cindy.castro@dss.ca.gov & Fax: 707-588-5099.

Based on LPAs' observations of the Licensee's (LS) pediatric CPR/First Aid certification which was expired and LS not furnishing a current EMSA approved CPR/First Aid certification for LS or S1. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: LIcensee stated she would enroll in an EMSA approved Pediatric CPR/First Aid training, complete the training and submit a copy of her current certificateion to the Department by 10/26/22 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099

Based on the Licensee not furnishing records for S1. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she would produce and personnel record for S1 and Licensee would submit a written statement certifying that she created a personnel record for S1.

Based on Department records which revealed the Licensee did not submit submit an updated application (LIC 279) to report three adults resided in the home. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee submitted an updated LIC 279 to list the adults residing in the home and the Licensee agreed to produce a written statement to detailing how she intends to report changes at the facility and comply with the the regulations.

Based on the Licensee not furnishing proof of immunity against Pertussis for S1. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she would obtain and submit required immunization for S1 to the Department by 10/26/22. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099

Based on the Licensee's statement which confirmed three adults resided in the home, A1 was at least 18 years in age and resided in the home and Department records confirming only two adults obtained a criminal record clearance. The licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Resolution: LPA informed Licensee that all adult 18 years and older residing in the home was required to obtained an approved criminal record clearance. Licensee stated she would send A1 to the UPS vendor to get Live Scan fingerprinted on 10/05/22 or by 10/06/22. The Licensee stated after A1 gets Live scan, Licensee would sbumit a copy of the LIC 9163 to the Department by 10/06/22.

Based on five children's (C1-C5) at 11:23am which revealed C2's record was missing Immunization Record (IR) and IR was not transcribed onto the CDPH 286. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she requested IR from C2's parent and the Licensee would obtain C2's immunization record from the parent and Licensee would submit evidence to show C2 was immunized prior to enrollment into care. The Licensee would submit her POC to the Department by 10/26/22 via mail, email or fax. Email: melchisedeck.augustin@.dss.ca.gov & Fax: 707-588-5099

Based on five children's (C1-C5) records reviewed at 11:23am which revealed a child (C2) under 12 months old did not have a completed LIC 9227. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she would provide C2's parent with the LIC 9227 for completion, and Licensee would submit a copy of the completed LIC 9227 to the Department by 10/26/22 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099.

Based on the Licensee's (LS) stated confirming an adult (A1) resided in the home, and LS not furnishing evidence of negative TB clearance for A1. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she would ensure A1 obtained evidence of negative TB clearance and Licensee would submit evidence of negative TB clearance for A1 to the Department by 10/26/22 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099

Based on five children's (C1-C5) records reviewed at 11:23am which revealed C2 & C5's LIC 700 were either incomplete or not signed by the child's parent or authorized representative. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she would submit verification to prove the licensing forms were either completed or signed by the child's parent or authorized representative.

Based on the Licensee's (LS) statement confirming she did not document 15 minute checks while C1 & C2 napped and LS not furnishing evidence to prove 15 minutes checks were conducted. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she would make additional copies of the Sleep Log and she would document seven days worth of 15 minute checks on the Sleep Log for C1 & C2, and the Licensee would submit evidence to prove that she initiated 15 minute checks for the infants while they napped. Email: melchisedeck.augustin@.dss.ca.gov & FAx: 707-588-5099

Based on the Licensee's (LS) statement validating she and S1 had not completed the training and LS not furnishing a current AB 1207 Mandated Reporter Training certificates for LS & S1. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Resolution: Licensee stated she and S1 would complete the online AB 1207 Mandated Reporter Training module at mandatedreporterca.com, and LS would submit the current certificates to the Department by 11/19/22 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099