115400539-9-9-2019-13-CC-DWIN-BFUU3V-20190909151410

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 115400539
Report Date: 09/09/2019
Date Signed: 09/09/2019 03:14:23 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	STAFFORD, REBECCA FAMILY DAY CARE		FACILITY NUMBER:	115400539
ADMINISTRATOR:	STAFFORD, REBECCA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 934-5813
CITY:	WILLOWS	STATE: CA	ZIP CODE:	95988
CAPACITY:	14	CENSUS: 2	DATE:	09/09/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Rebecca Stafford		TIME COMPLETED:	03:20 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	On 09/09/2019 an Annual/Random inspection was made to the facility by Licensing Program Analyst (LPA), David Wilson. Prior to this inspection a review of staff records on 09/03/2019 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During today’s inspection the home and grounds were toured. The licensee was supervising two children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s normal operating hours are 6:00am to 10:00pm, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits master bathroom was inaccessible with a high latch. The home is clean, orderly and comfortable. There are safe toys and equipment available for children. There is a working telephone in the home. The licensee has current pediatric CPR and First Aid certification, which expire in March 2020. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. Licensee stated poisons are locked in a detached garage, and none were observed to be accessible. There is a working smoke detector, carbon monoxide detector and charged fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are no firearms or ammunition in the home, and none were observed during today's inspection. Continued on next page...

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: David Wilson	TELEPHONE: (530) 513-0993
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2019

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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: STAFFORD, REBECCA FAMILY DAY CARE	FACILITY NUMBER: 115400539
	VISIT DATE: 09/09/2019

NARRATIVE

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The children use the back yard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed in the yard. Two children's records were reviewed; required emergency information was observed to be on file. The licensee is not providing Incidental Medical Services (IMS) to children in care. The Incidental Medical Services (IMS) policy was discussed with the licensee. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417 (See Evaluator Manual Regulation Interpretations and Procedures). 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 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, www.ada.gov/childqanda.htm.

This report, as well as the American Academy of Pediatrics Guide to Safe Sleep Practices brochure, were reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: David Wilson	TELEPHONE: (530) 513-0993
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2019

LIC809 (FAS) - (06/04)

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