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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 033621431
Report Date: 03/14/2022
Date Signed: 03/14/2022 11:32:41 AM


Document Has Been Signed on 03/14/2022 11:32 AM - 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:USELTON, JENNIFERFACILITY NUMBER:
033621431
ADMINISTRATOR:USELTON, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 256-4240
CITY:JACKSONSTATE: CAZIP CODE:
95642
CAPACITY:14CENSUS: 8DATE:
03/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Jennifer UseltonTIME COMPLETED:
11:40 PM
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At 9:45am Licensing Program Analyst (LPA) Aruna Sridharan met with licensee Jennifer Uselton for the purpose of unannounced annual inspection. One assistant and 8 children with 1 infant and 1 kindergarten and 6 preschool children. 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. 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) and yards on the both sides of the house. 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 06/2023. All staff files have proof of immunizations and Mandated reporter certificates. LPA observed Fire Drill Log (last drill on 02/22) 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: Justin L DentonTELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2022
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: 03/14/2022
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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

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/inspection-process.

Licensee Jennifer Uselton 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 [or facility representative] 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 that were evaluated during today's inspection. LPA read this report to the licensee; she stated that understands today’s inspection. Exit interview conducted and report was reviewed with the licensee Jennifer Uselton. A notice of site visit was given and must remain posted for 30 days.

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

DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022
LIC809 (FAS) - (06/04)
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