093609114-8-14-2019-03-CC-ESIA-BF2RF3-20190814125827

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093609114
Report Date: 08/14/2019
Date Signed: 08/14/2019 12:58:35 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:	PENN, KRISTINA LYNN		FACILITY NUMBER:	093609114
ADMINISTRATOR:	PENN, KRISTINA LYNN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 543-1212
CITY:	SOUTH LAKE TAHOE	STATE: CA	ZIP CODE:	96150
CAPACITY:	14	CENSUS: 10	DATE:	08/14/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Kristina Lynn Penn		TIME COMPLETED:	01:10 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) Elvira Sierra met with licensee, Kristina Lynn Penn for an unannounced annual random inspection. Upon arrival today's census was 10 (3 infant, 7 preschool) children. Also Licensee's husband and her daughter were also present supervising the children. All adults living in the home have obtained a criminal record clearance and is on file with Licensing Office. Licensee understands she must be present 80% of operating hours and must submit a change of location application if she relocates. A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include: Master bedroom and two sheds. Home has a working phone, functioning smoke and carbon monoxide detector and a 2A10BC fire extinguisher that meet standards established by the State Fire Marshall. Licensee stated there are no weapons in the home. Toxic and hazardous items; such as cleaning compounds and medications are inaccessible to children. Licensee understands that 100% supervision is required in unfenced areas while children are present. There are no bodies of water on the premises. Children’s files were reviewed and contained current immunization and emergency contact ID information. A current roster is being maintained and fire and disaster drills are conducted at least once every six month and are properly log. Current pediatric CPR and first aid certification was verified and expires on 08/19/19. Licensee stated that she is aware and she will submit proof of new CPR to Licensing. Licensee and assistant (husband) have proof of immunization on file in the facility. LPA reviewed the licensee on the new regulation AB 1207- California Child Care Worker: Mandated Reporter Training. The licensee must complete the training every two years starting January 1, 2018 and retain proof of completion in the facility file. The training can be could at: mandatedreporterca.com. LPA observed proof of completion. This provider is currently not providing IMS services to children in care. 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. Report continued on page 2..

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019

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: PENN, KRISTINA LYNN	FACILITY NUMBER: 093609114
	VISIT DATE: 08/14/2019

NARRATIVE

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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 advised the licensee on Safe Sleep Practices and SIDS; the licensee stated they are understood and practiced. She stated she uses cribs for sleeping infants and understand infants cannot sleep in car seats, swings or other items not intended for sleeping.

LPA verified the annual fees are current. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the licensee can request to be added to the distribution list to receive Quarterly Updates.

This facility evaluation report was reviewed and discussed with the licensee. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.

In the areas that were evaluated, no deficiencies were observed at the time of the inspection.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019

LIC809 (FAS) - (06/04)

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