034500295-9-15-2020-53-CC-ASRN-BTH2R7-20200915173704

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 034500295
Report Date: 09/04/2020
Date Signed: 09/15/2020 05:37:15 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:	BLUM, CHRISTINA AND JOSHUA		FACILITY NUMBER:	034500295
ADMINISTRATOR:	BLUM, CHRISTINA AND JOSHUA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 761-4568
CITY:	JACKSON	STATE: CA	ZIP CODE:	95642
CAPACITY:	14	CENSUS: 0	DATE:	09/04/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Joshua Blum		TIME COMPLETED:	12:30 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 conducted televisit due to COVID-19 State of Emergency for the purpose of change of location. The televisit was conducted on Google Duo. Licensee Joshua Blum and Christina Blum applied for a change of location for a large family child care home. Previously, licensee was licensed at different location with license number 33622120 at 66 Frontier Drive, Jackson CA 95642. The family child care home facility is three story single family home with four bedrooms and three bathrooms. Licensees live with two minor children. Licensee and staff have criminal background clearances. The daycare hours of operation are Monday through Friday from 7:00am to 6:00pm.. Off limit areas: Entire third level, garage and shed in the backyard. All off limits areas must be made inaccessible to children. Isolation of an ill child will be in Living room. Licensee was notified that prior to use of any off limits area, the department must be notified. LPA Sridharan tele-inspected the home with the applicant for health and safety hazards. The house has proper temperature and ventilation. All the toxic or dangerous materials are inaccessible to children. The fireplace in family room and the stairs are barricaded. The fireplace in kitchen is not in use. The house has a working telephone, fully charged fire extinguisher, smoke detector and carbon monoxide detector that meet regulations. There is first aid kit available. There is a variety of age appropriate toys available. As per the licensee, there are no firearms or weapons in the home. LPA discussed licensing regulations and capacity requirements. Licensing forms and posting requirements were reviewed with the licensee. During the inspection, LPA received copies of Deed, Lead Poisoning Prevention Completion certificate, CPR/First Aid Card that expires 10/21 and Mandated Reporter Certification expires 08/22. LPA observed the record of licensee’s immunization on file. During the inspection, LPA received updated Application and Current Children in home form from applicant. LPA requested children's roster from the licensee. 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: 09/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2020

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: BLUM, CHRISTINA AND JOSHUA	FACILITY NUMBER: 034500295
	VISIT DATE: 09/04/2020

NARRATIVE

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LPA informed applicant that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.
LPA also discussed Unusual Incident Reports (UIRs) and reporting requirements. LPA informed the Director 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.
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 discussed the inspection authority of the Department by authorized agent to enter and inspect the family child care home providing care, supervision and services at any time, with or without advance notice to secure compliance with the regulations in accordance with Section 102396.
LPA discussed that prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changes.
The applicant is encouraged to frequently visit website at http://www.ccld.ca.gov for licensing regulations and new updates. Applicant can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

LPA did not observe any violation of regulations. As of 09/04/2020, the license is granted for Large Family Child Care Home for this location. Copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2020

LIC809 (FAS) - (06/04)

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