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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093610094
Report Date: 10/23/2019
Date Signed: 10/23/2019 11:09:55 AM

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:KOFF, KATHRYNFACILITY NUMBER:
093610094
ADMINISTRATOR:KOFF, KATHRYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 941-1199
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:14CENSUS: 8DATE:
10/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kathryn KoffTIME COMPLETED:
11:25 AM
NARRATIVE
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Licensing Program Analysts (LPAs), Jan Hoshida and Michelle Pascual, met with Licensee, Kathryn Koff, for an unannounced random annual inspection and toured areas of the home accessible to children in care. Off-limit areas include entire upstairs, downstairs bedroom, laundry room, garage and all decking. Licensee acknowledged that children may never enter these off-limit areas. Licensee maintains 100% supervision to ensure that the children do not go out on the deck area. The census included eight children. Also present was Licensee’s assistant/daughter. Licensee stated there are no new residents in the home since licensure. All adult residents have criminal record clearances. The hours of operation are Monday through Friday from 7:00am to 5:00pm.

LPAs observed CPR/1st certificates which expired on 7/16/18. Licensee stated that she acknowledges that her CPR/1st certificates are past due and is currently enrolled in a CPR/1st for January 2020, but will find another course that occurs within the next month.

LPAs discussed recent changes in licensing requirements, including the posting of licensing inspection notices and reports and Parent Notification Requirements. LPA reviewed some children’s files.

LPA observed that there were no hazardous items accessible to children. LPA observed that cleaning materials were inaccessible. Fire extinguisher, smoke detector and carbon monoxide detector meet regulation. Toys appear to be safe. The backyard is fenced and gated.

Licensee stated there were weapons in the home and LPAs observed that the weapons were properly stored according to Title 22 regulations. Licensee stated that there is no ammunition within home.

There are no bodies of water observed.
REPORT CONTINUED ON NEXT PAGE
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2019
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: KOFF, KATHRYN
FACILITY NUMBER: 093610094
VISIT DATE: 10/23/2019
NARRATIVE
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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.

LPA discussed the new Mandated Reporter Training with Licensee. Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. In addition, existing Licensees must meet requirements by March 30, 2018. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: HTTP://WWW.MANDATEDREPORTERCA.COM/. The training is currently provided in English. AB1207 Training.

LPAs did not observe current Mandated Reporter Training on file for Licensee and her assistant/daughter. Licensee stated that she was unaware of the online Mandated Reporter requirement, but will take the training as soon as possible and submit to LPAs.

LPAs checked facilities fees and confirmed that it is up to date.

LPAs provided the Community Care Licensing’s website www.ccld.ca.gov, so the Licensee can obtain updated licensing information, new regulations and access forms. LPA advised Licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws CHILDCAREADVOCATESPROGRAM@DSS.CA.GOV.

In the areas that were evaluated, deficiencies were observed at the time of the visit and cited on LIC 809-D. An exit interview was conducted and report was reviewed with Licensee who stated they understand today’s inspection. Notice of Site Visit was posted and Licensee understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2019
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: KOFF, KATHRYN
FACILITY NUMBER: 093610094
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/25/2019
Section Cited

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... licensees of family day care homes shall ensure that at least one staff member who has a current course completion card in pediatric first aid and pediatric CPR... shall be onsite at all times when children are present at the facility, and shall be present wtih the children when children are offsite
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from the facility for facility activities...

This requirement was not met as evidenced by: LPAs did not observe current CPR/1st aid certification for Licensee. This poses a potential risk to the health and safety to the children in care.
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Type B
11/25/2019
Section Cited

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training ...and shall complete renewal mandated reporter training every two years
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following the date on which he or she completed the initial mandated reporter training. This requirement was not met as evidenced by: LPAs did not observe certification for online Mandated Reporter training. This poses a potential risk to the health and safety to the children in care.
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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: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2019
LIC809 (FAS) - (06/04)
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