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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093613009
Report Date: 04/19/2022
Date Signed: 04/19/2022 02:20:49 PM


Document Has Been Signed on 04/19/2022 02:20 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:BUCKMASTER, KIMBERLYFACILITY NUMBER:
093613009
ADMINISTRATOR:BUCKMASTER, KIMBERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 798-9961
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:14CENSUS: DATE:
04/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Kimberly BuckmasterTIME COMPLETED:
02:50 PM
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On 04/19/2022 Licensing Program Analysts (LPAs) Arianna Manabat and Gagandeep Singh met with Licensee Kimberly Buckmaster for an unannounced annual / one year inspection. During the inspection there were no day care children present. All individuals subject to criminal background review have obtained a criminal record clearance.

The home is a three-story home and the on-limits areas include the bottom play space, the bottom kitchen, the upstairs bathroom, the bottom stairs bathroom, and a fenced backyard. The off-limit areas are the, entire third floor upstairs area, the patio, laundry room, bottom stairs bedroom, and the garage. There are no firearms. There is a locked and secured spa on the premises that has four separate ties. LPAs observed that the spa was not filled at this time.

A health and safety inspection was conducted in the areas accessible to children. The house has a working telephone, fully charged fire extinguisher, smoke detector and carbon monoxide detector that meet regulations. LPAs observed all the required postings. LPAs advised the licensee that if there are any poisons at the home, all poisons must be locked with a key lock or combination lock. LPAs did not observe a fireplace.

Licensee has all of her immunization records current. Children's roster and a fire drill log were observed, the last fire drill was conducted on February 8th, 2022. Licensee’s and Aide’s CPR/First aid card had an expiration date of 07/2022. Mandated Reporter Training for the Licensee was discussed. The Licensee had a completed Mandated Reporter training that expires in March 2024. Licensee is aware that the Mandated Reporter Training needs to be completed every two years.

Report continues on 809C................

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) -26-1414
LICENSING EVALUATOR NAME: Arianna ManabatTELEPHONE: (279) 200-2886
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2022
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: BUCKMASTER, KIMBERLY
FACILITY NUMBER: 093613009
VISIT DATE: 04/19/2022
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. No deficiencies were cited during today’s inspection. Exit interview conducted and report was reviewed with the Licensee Kimberly Buckmaster.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) -26-1414
LICENSING EVALUATOR NAME: Arianna ManabatTELEPHONE: (279) 200-2886
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2