053622627-10-10-2024-53-CC-TLAE-D9WQQT-20241010122253

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 053622627
Report Date: 10/10/2024
Date Signed: 10/10/2024 12:23:02 PM

Document Has Been Signed on 10/10/2024 12:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	ARLEDGE, DEBORAH		FACILITY NUMBER:	053622627
ADMINISTRATOR:	DEBORAH ARLEDGE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 623-7615
CITY:	VALLEY SPRINGS	STATE: CA	ZIP CODE:	95252
CAPACITY:	14	CENSUS: 0	DATE:	10/10/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Licensee, Deborah Arledge		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 Analysts (LPA) Tobias Lake met with Licensee, Deborah Arledge, for the purpose of an unannounced annual inspection who accompanied LPA on a tour of the home. The facility was closed today but Licensee was okay with conducting an annual visit. There were no children present at the time of inspection. Licensee's operating hours are Monday through Friday from 7:00 AM to 6:00 PM. Licensee 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. A health and safety inspection was conducted in all areas accessible to children. The off-limits areas in the home are the master bedroom, the first bedroom on the right, garage, and backyard sheds per Licensee’s request. LPAs observed the required postings and a working phone. 2A10BC fire extinguisher meets regulations. LPAs observed smoke and carbon monoxide detectors and verified they were both functional. LPAs toured the kitchen area and verified knives were inaccessible to children in care. LPAs observed playroom area with age-appropriate toys for children. LPAs observed a bathroom and verified that hazardous and toxic items were inaccessible to children in care. LPAs observed a wooden stove and space heaters. Licensee stated the front panels do not get hot. LPAs verified that weapons and ammunition were stored in separate locked safes. There is a hot tub located in the backyard. LPAs observed locks on all four sides of the hot tub cover. Outdoor play space is unfenced and Licensee understands 100% supervision of children is required in unfenced play areas. Children's files were reviewed. Emergency information and required immunization records were on file. LPAs observed a current roster and documentation that a fire drill is conducted at least once every six months. Licensee's immunization records are available in the facility file. Current EMSA pediatric CPR and First Aid certification was verified and expires 01/2025 and Child Care Provider Mandated Reporter certification was verified and expires 08/8/2025. Continues on 809-C

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Tobias Lake	TELEPHONE: 916-224-9388
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ARLEDGE, DEBORAH	FACILITY NUMBER: 053622627
	VISIT DATE: 10/10/2024

NARRATIVE

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LPAs discussed the safe sleep regulations with Licensee 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. LPAs also informed Licensee 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. LPAs observed the requirement infant napping logs and the LIC 9227, Individual Sleeping Plan, for infants under 12 months.

This provider is currently providing Incidental Medical Services (IMS) to children in care. LPAs reviewed storage of medication, and child personnel records. For IMS information, see PIN 22-02-CCP. 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

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive e-mail communication. Licensee was encouraged to visit the Department’s website athttp://ccld.ca.gov/ for information regarding child care updates, forms, regulations and legislation pertaining to Family Child Care Homes. To improve the quality and value of the new inspection process, a survey will be sent to the e-mail 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 e-mail 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.

CONTINUED ON LIC809C

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Tobias Lake	TELEPHONE: 916-224-9388
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ARLEDGE, DEBORAH	FACILITY NUMBER: 053622627
	VISIT DATE: 10/10/2024

NARRATIVE

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During the exit interview, the Licensee, Deborah Arledge, confirmed there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California. LPA reminded Licensee to advise the department of any and all facility closures (vacations, Holidays, and illness).

In the areas that were evaluated, no deficiencies were cited during today’s inspection.

An exit interview was conducted and report was reviewed with the licensee, Deborah Arledge. A copy of the report was provided to the licensee. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Tobias Lake	TELEPHONE: 916-224-9388
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC809 (FAS) - (06/04)

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