033621431-1-14-2020-53-CC-ASRN-BKTT7H-20200114132846

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 033621431
Report Date: 01/14/2020
Date Signed: 01/14/2020 01:29:02 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:	USELTON, JENNIFER		FACILITY NUMBER:	033621431
ADMINISTRATOR:	USELTON, JENNIFER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 223-1920
CITY:	JACKSON	STATE: CA	ZIP CODE:	95642
CAPACITY:	14	CENSUS: 11	DATE:	01/14/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Jennifer Uselton		TIME COMPLETED:	01:45 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	At 11:00am Licensing Program Analyst (LPA) met with licensee Jennifer Uselton for the purpose of unannounced annual inspection. The assistant just walked in after LPA entered the facility. The facility operates Monday through Friday from 6:30am to 5:30pm. LPA toured all areas of the home that are accessible to the children. Today’s census was eleven children with 9 preschool aged children and 2 infants. LPA observed that all adult residents residing have criminal record clearances. LPA advised licensee if anyone over the age of 18 years old in the home they must have a criminal record clearance as well. LPA observed posting of the license, Parent's Rights and the current disaster plan. Off-limit areas include garage, master bathroom and craftroom(bedroom on the left of hallway). Licensee acknowledged that children may never enter these off-limit areas. The backyard is fenced and licensee acknowledges that children may never be left unsupervised in an unfenced area of the yard. Licensee stated there are no weapons in the home and LPA observed that there are no bodies of water on the property. There is no fireplace. LPA observed that poisons are locked and that fire extinguisher, smoke detector and carbon monoxide detector meets regulation. Cleaning materials, hazardous items and medications are all inaccessible to children. There is a working telephone, toys appear to be in a safe condition and the home appears to be clean and orderly. LPA observed current CPR and First Aid certificates that expires on 04/2020. All the assistants have CPR and First Aid certifications and Mandated reporter certificates. LPA observed Fire Drill Log and current roster. LPA observed all children's files and the required forms were duly signed by the authorized representative. Affidavit form needs to be in children's files. Report continues on 809C....

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020

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: USELTON, JENNIFER	FACILITY NUMBER: 033621431
	VISIT DATE: 01/14/2020

NARRATIVE

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LPA discussed the new Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care facility must have immunization against measles, pertussis and influenza. LPA conducted file reviews and observed licensee had proof of immunization.

LPA also discussed the Incidental Medical Services (IMS) policies with the licensee. The facility is not currently providing IMS. If the licensee plans to provide IMS in the future she can refer to: 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: www.ada.gov/childqanda.htm

LPA also discussed Unusual Incident Reports (UIRs) and reporting requirements. LPA informed the licensee that if any unusual incidents occur she must contact the Department within 24 hours and an UIR must be submitted with 7 day, describing the specifics to the incident.
LPA advised the licensee on Safe Sleep Practices and SIDS; the licensee stated they are understood and practiced. She stated she uses porta cribs for sleeping infants and understand infants cannot sleep in car seats, swings or other items not intended for sleeping.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised the licensee that it is her responsibility to stay up-to-date and informed in regards to new regulations.

No Title 22 Deficiencies observed in the areas that were evaluated during today's inspection. LPA read this report to the licensee; she stated that understands today’s inspection. Notice of Site Visit posted and the licensee understands it must remain posted for 30 days. Appeal rights were provided to Licensee.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020

LIC809 (FAS) - (06/04)

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