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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 065407539
Report Date: 11/06/2019
Date Signed: 11/15/2019 10:29:58 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:CALLAHAN/TOMLIN FAMILY CHILD CARE HOMEFACILITY NUMBER:
065407539
ADMINISTRATOR:JENNIFER CALLAHAN, BAILEEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 330-7615
CITY:ARBUCKLESTATE: CAZIP CODE:
95912
CAPACITY:14CENSUS: 1DATE:
11/06/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Jennifer CallahanTIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Laura Chavez conducted a prelicensing inspection to the home in response to an application for a capacity of 8. During today's inspection the applicant was providing exempt care to one child. The applicant is the property owner. Days and hours of operation will be Monday-Friday 7:30am-5:30pm. The applicant understands that child care must be provided in the "primary" residence of the applicant. The applicant understands that 24 hour care shall not be provided to one child at any one time. The home was toured inside and out. The residence is a three bedroom/two bath home. The off-limits areas of the home are the garage, master bedroom/bathroom and bedroom #2, and were made inaccessible by locks, doorknob covers and gate. Two adults and one minor reside in the home. The home is clean and orderly at this time and will remain so during child care hours. Cords to window blinds were not accessible. There is a working telephone. The sharp knives, medicines, are stored out of the reach of children. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. Poisons are locked in the garage. There are age appropriate toys available for the children. There is a working smoke detector, carbon monoxide detector and a fully charged fire extinguisher in the home. The firearms and or other dangerous weapons in the home are locked as required. Notification of Parents Rights, Emergency Disaster Plan with the Earthquake Preparedness Checklist shall be posted. The floor and yard plan were verified. The gas fireplace located in the living-room has been professionally disconnected as well as a plate cover placed over the switch. The applicant understands that the fireplace shall be screened as required should it be used when children are in care.

Report continued: See LIC 809-C, pages 2 & 3
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: CALLAHAN/TOMLIN FAMILY CHILD CARE HOME
FACILITY NUMBER: 065407539
VISIT DATE: 11/06/2019
NARRATIVE
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The children will use the back yard as the outdoor play area and it is fully fenced. There is a duck pond located in the off-limits area of the backyard. The pond has been completely enclosed with wire mesh fencing. LPA tested the gate and observed the gate to self-close, and self latch. The self-latching device is located no more than six inches from the top of the gate. The applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. All minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday and obtain a TB clearance. The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance. Currently the applicant does not carry liability insurance for her family child care home. The applicant understands that parents will be required to sign insurance affidavits. A sample of forms typically given during prelicensing inspections were provided and explained. The roster shall remain current at all times. Children's records are to be maintained and kept current at all times. The applicant was reminded of the responsibility of reporting unusual incidents to CCL (within 24 hours or the next business day). The applicant will maintain current Pediatric CPR and First Aid certification. The applicant shall be present in the home and shall ensure that children in care are supervised by an adult with a criminal background clearance and current Pediatric CPR and First Aid certification. The applicant understands that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. The applicant understands the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school-age. Smoking is prohibited in the home at all times and in outdoor areas where children are present. 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 of operation must be submitted to the Department. The following information regarding the American Disabilities Act (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.The applicant understands the responsibility to read and have knowledge of the laws and regulations for operation of a family child care home.


Report Continued: See LIC809-C, page 3
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: CALLAHAN/TOMLIN FAMILY CHILD CARE HOME
FACILITY NUMBER: 065407539
VISIT DATE: 11/06/2019
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Page 3

Forms and regulations must be obtained from the website (http://ccld.ca.gov/). Megan's Law web site was provided (http://www.meganslaw.ca.gov). The applicant understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice. This report, as well as the handout from the American Academy of Pediatrics, Guide to Safe Sleep Practices were reviewed and discussed with the applicant. The applicant was also made aware of the upcoming infant regulations which include Safe Sleep Concepts and Individual Infant Sleeping Plan. The applicant understands the responsibility of securing copies of forms and regulations from the website(http://ccld.ca.gov/). All licensing reports are public information and must be made available upon request for at least three years.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

The following is required prior to licensing the home:
1. Criminal Record Statement LIC508 for Joseph Callahan.
2. Proof of current immunity or exemption from immunity from Influenza, Pertussis, and Measles.
3. Proof of posting Notification of Parents Rights, Emergency Disaster Plan with the Earthquake
Preparedness Checklist
4. Final application and supervisor review.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3