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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 123006897
Report Date: 10/23/2019
Date Signed: 10/23/2019 12:00:44 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:ANDERSEN, CHERYL FAMILY CHILD CARE HOMEFACILITY NUMBER:
123006897
ADMINISTRATOR:ANDERSEN, CHERYLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 442-6383
CITY:EUREKASTATE: CAZIP CODE:
95503
CAPACITY:14CENSUS: 5DATE:
10/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Cheryl AndersenTIME COMPLETED:
12:30 PM
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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 10/22/19 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 5 children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicles. The facility’s operating days and hours are 7:30 a.m. to 5:30 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: all bedrooms, master bathroom, and garage and made inaccessible by gates and/or locked/latched doors. The home is clean, orderly and comfortable. There are safe toys and equipment available for children. There is a working telephone in the home. Woodstove is barricaded by fencing. Licensee stated there are no weapons in the home, and LPA did not observe any. The Licensee has current pediatric CPR and First Aid certification, and expires on 07/31/21. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) are stored in inaccessible areas out of reach of children. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. There are no bodies of water on the property. The children use the backyard as an outdoor play area and it is fully fenced. Three children's records were reviewed at 11:30 a.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.

The facility is in substantial compliance during today's visit. No Title 22 deficiencies have been cited during today's inspection. An Exit Interview was conducted, and a Notice of Site Visit was provided to the Licensee.

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: 10/23/2019
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)
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