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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 034500295
Report Date: 08/11/2021
Date Signed: 08/12/2021 08:46:00 AM

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 JOSHUAFACILITY NUMBER:
034500295
ADMINISTRATOR:BLUM, CHRISTINA AND JOSHUAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 588-3455
CITY:JACKSONSTATE: CAZIP CODE:
95642
CAPACITY:14CENSUS: 6DATE:
08/11/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Joshua BlumTIME COMPLETED:
01:45 PM
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On 08/11/21 Licensing Program Analyst (LPA) Aruna Sridharan met with licensee Joshua Blum and assistant Allen for unannounced annual inspection. LPA followed infection control protocols. All residents and staff present had fingerprint clearances.

The family child care home facility is three story single family home with four bedrooms and three bathrooms. Today's census was one infant and 5 preschools. 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. Licensee acknowledges that children may never enter these off-limit areas. The backyard is fenced. Isolation of an ill child will be in the living room. 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 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. The first aid kit is located in the entry closet. As per the licensee, there are no firearms or weapons in the home. LPA observed cleaning compound's and medications stored in upper cabinet in the kitchen.
Safe toys and play equipment are observed. LPA observed all the required postings, reviewed all staff and childrens records.
LPA discussed the Safe Sleep regulations. LPA observed the record of licensee’s immunization on file. LPA reviewed children's roster and fire drill log last conducted on 06/30/21. LPA requested a copy of children's roster from the licensee.

The facility is following all the Covid precautions while providing care for children.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the Licensee and provided copies. An exit interview was conducted. Appeal rights provided. Notice of Site Visit was provided, and licensee understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
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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