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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 121373038
Report Date: 10/16/2019
Date Signed: 10/16/2019 04:15:57 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:POWELL, LINDA A. FCCHFACILITY NUMBER:
121373038
ADMINISTRATOR:POWELL, LINDA A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 444-8453
CITY:EUREKASTATE: CAZIP CODE:
95503
CAPACITY:14CENSUS: 13DATE:
10/16/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Linda PowellTIME COMPLETED:
04:45 PM
NARRATIVE
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An annual inspection was made to the facility by Licensing Program Analyst (LPA) Kiriko Lynch. A review of staff records on 10/07/19 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances and/or exemptions. During today’s inspection the home and grounds were toured. The Licensee and her assistant were supervising 13 children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicles. The facility’s operating hours are 7:30 a.m. to 4:30 p.m., Monday–Friday, and closed on holidays. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are: laundry room, storage room, woodshop, and backyard, and made inaccessible by locked doors and/or gates and fencing. The home is clean, orderly and comfortable. There are safe toys and equipment available for children. There is a working telephone in the home. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) are stored in inaccessible areas out of reach of children. Licensee stated there are no weapons in the home, and LPA did not observe any. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The children use the front yard as an outdoor play area and it is fenced, and Licensee stated she and her assistant are always outside with the children. Three children's records were reviewed at 4:00 p.m. and 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. When IMS is provided, a Plan for Providing IMS shall 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 AAP Guide to Safe Sleep Practices brochure and updated mandated reporter training, 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. An Exit Interview was conducted, and a Notice of Site Visit was provided to the Licensee. See next page for deficiency cited.

Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
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: POWELL, LINDA A. FCCH
FACILITY NUMBER: 121373038
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/16/2019
Section Cited

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Personnel Requirements -
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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This requirement was not met as evidenced by: During the inspection LPA observed Licensee's CPR/First Aid certification card was expired.
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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: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2019
LIC809 (FAS) - (06/04)
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