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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 030318260
Report Date: 03/06/2020
Date Signed: 03/06/2020 02:14:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:ELISKOVICH, LORIFACILITY NUMBER:
030318260
ADMINISTRATOR:ELISKOVICH, LORIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 267-5534
CITY:SUTTER CREEKSTATE: CAZIP CODE:
95685
CAPACITY:14CENSUS: 0DATE:
03/06/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Lori EliskovichTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Aruna Sridharan met with Lori Eliskovich for the purpose of random annual inspection. The purpose of the inspection was stated to licensee. The facility is a two storey home with 3 bedrooms and 2 bathrooms. Today's census was 0 children. The licensee operates from 7:00am to 5:00pm from Monday through Friday. All individuals subject to criminal background review have obtained a criminal record clearance.

The off-limit areas are entire upstairs, garage and pantry. A health and safety inspection was conducted in all areas accessible to children. LPA observed a working phone, 2A10BC fire extinguisher, functioning smoke and carbon monoxide detectors. Licensee stated there are no weapons in the home. Fireplace is inoperable during operation hours. Toxic and hazardous items; such as cleaning compounds and medications are inaccessible to children. Outdoor play space is fully fenced; the licensee understands that children need 100% supervision is required in unfenced areas. LPA observed a pool that meets regulation. The house is clean and orderly, toys are in good repair.

All the required postings were posted A current roster is being maintained and fire and disaster drills are documented, the last fire drill documented is 01/20. Licensee has current CPR/First Aid which expires 02/2021. Licensee has Mandated Reporter certificate (AB1207) which expires on 02/22.

All 3 children's files were reviewed and all the files had the required forms duly signed by parent/guardian. Licensee had all immunizations on file.
Report continues on page 809C..........
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: ELISKOVICH, LORI
FACILITY NUMBER: 030318260
VISIT DATE: 03/06/2020
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This provider is currently not providing IMS services to children in care. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA advised the licensee on Safe Sleep Practices and SIDS; the licensee stated they are understood and practiced. She stated she uses cribs for sleeping infants and understand infants cannot sleep in car seats, swings or other items not intended for sleeping.

Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information. LPA verified the annual fees are current. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the licensee can request to be added to the distribution list to receive Quarterly Updates.

No Title 22 deficiencies were observed in the areas that were evaluated in today's inspection. This facility evaluation report was reviewed and exit interview conducted with the licensee. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form. Appeal rights were provided to licensee.

SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
LIC809 (FAS) - (06/04)
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