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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093609336
Report Date: 11/21/2019
Date Signed: 11/21/2019 02:14:15 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:PETERS, TERIFACILITY NUMBER:
093609336
ADMINISTRATOR:PETERS, TERIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 941-0870
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:14CENSUS: 11DATE:
11/21/2019
TYPE OF VISIT:Annual/RandomANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Teri PetersTIME COMPLETED:
02:20 PM
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LPA Michelle Pascual met with licensee Teri Peters and her assistant Brittani Peters for the purpose of an annual random visit. All individuals subject to criminal background review have obtained a criminal record clearance.

A health and safety inspection was conducted in all areas accessible to children. Adequate supervision was observed. Off-limits areas include: Entire upstairs of main house, Guest Quarters above preschool class, garage, deck and entire backyard area of the main house. Upon inspection LPA observed eleven (11) children on the premises. LPA also observed a working phone, 3A40BC (2) fire extinguisher, first aid kit and functioning smoke detectors. Licensee has working smoke detectors and Carbon monoxide detectors in both the preschool area and the main house. LPA also observed current CPR certificates that expire 7/2020 for both the Licensee and assistant. Per licensee, there are no weapons in the home. No children were observed in parked cars. There is a pool onsite; however it’s located in the off- limit area and its inaccessible to children. Licensing staff observed that the pool was made inaccessible with a wrought iron fence that meets regulation, and a self-closing, self-latching gate.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Michelle PascualTELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
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 2
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: PETERS, TERI
FACILITY NUMBER: 093609336
VISIT DATE: 11/21/2019
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LPA discussed with licensee regarding 100% supervision of the inaccessible bodies of water. Toxic and hazardous items are inaccessible to children. Safe toys and comfortable accommodations were observed. The fireplace/stairs in the home were appropriately barricaded to prevent access by children. Outdoor play space is fenced/supervised. Operating hours are Monday through Friday 8:30am to 11:30am and 12:00pm to 3:00pm.

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.

No citations were issued during visit.

LPA discussed lead testing with Licensee and provided a brochure.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Michelle PascualTELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
LIC809 (FAS) - (06/04)
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