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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 033617644
Report Date: 10/19/2021
Date Signed: 10/19/2021 06:09:50 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:HESPELER, SUSANFACILITY NUMBER:
033617644
ADMINISTRATOR:HESPELER, SUSANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 245-6393
CITY:PLYMOUTHSTATE: CAZIP CODE:
95669
CAPACITY:14CENSUS: 5DATE:
10/19/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
04:55 PM
MET WITH:Susan HespelerTIME COMPLETED:
06:11 PM
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On 10/19/21 Licensing Program Analyst (LPA) Aruna Sridharan met with licensee Susan Hespeler for unannounced annual inspection. LPA followed infection control protocols. The hours of operation are 7:00am to 5:00pm Monday through Friday.

The family child care home facility is single story family home with three bedrooms, two bathrooms, living room, kitchen and garage. Today's census is 5 children including 4 preschoolers and 1 school age child. Off limit areas: three bedrooms, garage and backyard. Licensee acknowledges that children may never enter these off-limit areas. The side yard is fenced where children's outdoor play area is set up. Licensee was notified that prior to use of any off limits area, the department must be notified.

A tour of the home, inside and outside, as shown on the facility sketch was conducted. The house has a working telephone, fully charged fire extinguisher, smoke detector and carbon monoxide detector that meet regulations. The first aid kit is located in the daycare closet. As per the licensee, there are firearms locked separately. LPA observed cleaning compound's under the kitchen sink and cabinet next to bathroom with child safety latch. Medications were stored in cabinet above the sink. Licensee informed that she does not provide overnight care.

Safe toys and play equipment are observed. LPA observed all the required postings, reviewed all staff and childrens records. Licensee mandated reporters and staff did not have proof of immunizations. As it is potential risk to the health and safety of chidren, Type B deficiencies are sited on 809D page.

LPA advised the facility to follow all the Covid precautions while providing care for children.
Report continues on 809C page...
SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021
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
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: HESPELER, SUSAN
FACILITY NUMBER: 033617644
VISIT DATE: 10/19/2021
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LPA reviewed children's roster and fire drill log last conducted on 09/21. LPA requested a copy of children's roster from the licensee. Licensee had CPR/First aid card that expires on 10/23.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

No Title 22 Deficiencies observed in the areas of today's facility evaluation are on 809D page.. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee.

SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021
LIC809 (FAS) - (06/04)
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