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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093603141
Report Date: 06/27/2023
Date Signed: 06/27/2023 04:12:31 PM


Document Has Been Signed on 06/27/2023 04:12 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:CEDUSKY, KIMBERLYFACILITY NUMBER:
093603141
ADMINISTRATOR:CEDUSKY, KIMBERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 677-3775
CITY:CAMERON PARKSTATE: CAZIP CODE:
95682
CAPACITY:14CENSUS: 5DATE:
06/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Kimberly CeduskyTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst Erwina Pascual-Golamco (LPA) conducted an unannounced annual inspection and met with Licensee, Kimberly Cedusky. LPA observed 5 children in care with licensee. Cleared assistant came in during inspection. Facility hours of operation are Monday through Friday 7:00 AM - 6:00 PM. LPA observed that the annual facility fees are current.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Off limit areas include: south side of yard and shed. Licensee acknowledged that children may never enter these off-limit areas. Licensee requested LPA to include the master bathroom accessible to children, LPA conducted a health and safety inspection and observed that the master bathroom is ready to be an area accessible to children. The facility is clean, sanitary, and in good repair with ventilation. LPA observed the required documents were posted where visible to parents. Technical assistance provided regarding hazardous items—such as cleaning compounds, medications, or sharp objects—accessible to children. LPA observed chemicals in outdoor play are and garage floor near the door where children and families drop off and pick up. Licensee’s assistant removed the chemicals and made it inaccessible to children during visit. The fire extinguisher appeared to be in working condition and accessible. LPA observed the smoke and carbon monoxide detectors are functioning. The facility has equipment and age appropriate toys for children. The backyard is fenced, and licensee acknowledged that in areas that are not fenced, 100% supervision is required. Licensee stated there are no firearms on the premises. LPA did not observe any bodies of water on the premises.

continued...
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Erwina Pascual-GolamcoTELEPHONE: (916) 206-1524
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023
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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CEDUSKY, KIMBERLY
FACILITY NUMBER: 093603141
VISIT DATE: 06/27/2023
NARRATIVE
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LPA observed a current children's roster and fire drill log. LPA reviewed children’s files and observed that all the required documentation was present in each child's file. LPA observed the CPR/First Aid certificate was current. Technical assistance provided regarding Mandated Reporter certificate for licensee. Licensee was reminded the Child Care portion must be completed every two years. LPA reviewed staff and facility files and observed the required documentation.

LPA discussed with licensee the safe sleep regulations and the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

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SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Erwina Pascual-GolamcoTELEPHONE: (916) 206-1524
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CEDUSKY, KIMBERLY
FACILITY NUMBER: 093603141
VISIT DATE: 06/27/2023
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries 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. 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.

Type A deficiency (see continuation) was issued today. The licensee is informed to provide a copy of the Evaluation Report and the Type “A” Deficiency cited to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated
LIC 9224 shall be maintained in all children's files.

Exit interview conducted and report was reviewed with Licensee. During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. This report and appeal rights were provided and reviewed with the licensee. Notice of Site Visit shall remain posted for 30 days.
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Erwina Pascual-GolamcoTELEPHONE: (916) 206-1524
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/27/2023 04:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: CEDUSKY, KIMBERLY
FACILITY NUMBER: 093603141

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, LPA observed Poisons, detergents, cleaning compounds, medicines, and other items which could pose a danger accessible to children in the outdoor play area, garage floor (where families drop off and pick up), and master bedroom, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/28/2023
Plan of Correction
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Licensee's assistant removed chemicals and made inaccessible to children before LPA left the facility.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Erwina Pascual-GolamcoTELEPHONE: (916) 206-1524
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 06/27/2023 04:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: CEDUSKY, KIMBERLY
FACILITY NUMBER: 093603141

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above, LPA observed an expired mandated reporter in 2017 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/18/2023
Plan of Correction
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Licensee will email LPA attestation of a current mandated reporter for herself and staff/assistant by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Erwina Pascual-GolamcoTELEPHONE: (916) 206-1524
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023
LIC809 (FAS) - (06/04)
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