033622932-3-5-2020-53-CC-ASRN-BMESSY-20200305130844

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 033622932
Report Date: 03/05/2020
Date Signed: 03/05/2020 01:08:55 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:	CABLE, CHONG		FACILITY NUMBER:	033622932
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	03/05/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Chong Cable		TIME COMPLETED:	01:15 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	Licensing Program Analyst (LPA) Aruna Sridharan met with licensee Chong Cable for an annual random inspection. Upon arrival the purpose of today's inspection was stated. Today's census was 6 children with 2 infants, 3 preschoolers and 1 school aged child. The facility operates Monday-Friday 6:00AM-5:00PM. LPA toured all areas of the home that are accessible to the children. 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 advised licensee that she shall notify the department prior to making alterations or additions to the family home like but not limitedoff-limits, pools, decks, shed. Off-limit areas include master bed/bath, garage, and backyard. 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 that there are no weapons in the home. LPA observed that there are no bodies of water. The fireplace is blocked by entertainment center. 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. Licensee is planning to clean up backyard and garage to later apply to put them on limits. Licensee does provide transportation for pickup. Licensee acknowledges that only drivers licensed for the type of vehicle to be operated shall be permitted to transport children in care, the manufacturer's rated seating capacity of the vehicle shall not be exceeded, motor vehicles used to transport children in care shall be maintained in safe operating condition, and all vehicle occupants must be secured in an appropriate restraint system. 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: 03/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020

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: CABLE, CHONG	FACILITY NUMBER: 033622932
	VISIT DATE: 03/05/2020

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
26
27
28
29
30
31
32

LPA observed posting of the license, Parent's Rights and the current disaster plan.
LPA observed current CPR and First Aid certificate that expires on 09/2020 and mandated reporter certificate expires on 11/2020. LPA observed Fire Drill Log and the last fire drill was conducted on 09/2019. LPA observed all children's files and the required forms were duly signed by the authorized representative.
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 reviewed licensee's personnel records and observed licensee has 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 days, 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 lead exposure handout to the licensee.

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: 03/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2