053621738-4-30-2019-03-CC-JLDN-BBQUNH-20190430154357

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 053621738
Report Date: 04/30/2019
Date Signed: 04/30/2019 03:44:06 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:	VOLLSTEDT, ELOISE		FACILITY NUMBER:	053621738
ADMINISTRATOR:	VOLLSTEDT, ELOISE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 269-0517
CITY:	VALLEY SPRINGS	STATE: CA	ZIP CODE:	95252
CAPACITY:	14	CENSUS: 5	DATE:	04/30/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Eloise Vollstedt		TIME COMPLETED:	04:00 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) Justin Denton met with Eloise Vollstedt, Licensee for an unannounced random annual inspection and toured areas of the home accessible to children in care. Off-limit areas include the master bedroom/bathroom, hall bathroom, laundry room, garage, and outbuildings. Licensee acknowledged that children may never enter these off-limit areas. The census included 8 children ages 2 to 12. Licensee stated there are no new residents in the home since licensure. All Adult residents have criminal record clearances. LPA observed current CPR/First Aid certificates which expire on 9/23/20. LPA discussed recent changes in licensing requirements, including the posting of licensing inspection notices and reports and Parent Notification Requirements. LPA reviewed three children’s files. LPA observed fire drills were conducted at least once every six months and documented. LPA observed that there were no hazardous items accessible to children. LPA observed wood stove fireplace which was screened. LPA observed that cleaning materials were inaccessible. Licensee stated that there are weapons in the home. LPA observed guns stored appropriately. LPA observed ammunition stored on the shelf in the bedroom closet. Fire extinguisher, smoke detector and carbon monoxide detector meet regulation. Toys appear to be safe. The backyard is fenced and gated. There is an above ground pool on the property which is completely surrounded by a see through wood fence that is at least 5 feet high. LPA observed the gate to self-close and self-latch. There are no windows or doors that provide direct access into the pool area.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Justin L Denton	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2019

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: VOLLSTEDT, ELOISE	FACILITY NUMBER: 053621738
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/30/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/01/2019 Section Cited CCR 102417(g)(4)	1 2 3 4 5 6 7	Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee will ensure that all ammunition is stored and locked separately from firearms as required by regulation by due date. Civil penalty assessed.
	8 9 10 11 12 13 14	LPA observed ammunition stored on shelf of closet in master bedroom.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Justin L Denton	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2019

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: VOLLSTEDT, ELOISE	FACILITY NUMBER: 053621738
	VISIT DATE: 04/30/2019

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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.

LPA discussed recent changes in licensing requirements, including SB 277 (no longer accepting religious beliefs for immunizations) and SB 792 pertaining to immunization requirements for children and staff - Licensee provided proof of staff immunization's.

LPA discussed the new Mandated Reporter Training with licensee. Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. In addition, existing licensees must meet requirements by March 30, 2018. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English.

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 licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

Title 22 Deficiencies have been cited on the attached LIC 809D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's files
This report was reviewed and discussed with licensee. A notice of site visit and appeal rights were provided.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Justin L Denton	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2019

LIC809 (FAS) - (06/04)

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