173009037-7-5-2019-01-CC-CARD-BDSR5P-20190705124329

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 173009037
Report Date: 07/05/2019
Date Signed: 07/05/2019 12:43:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME:	PIKE, JANELL FCCH		FACILITY NUMBER:	173009037
ADMINISTRATOR:	PIKE, JANELL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 987-4622
CITY:	HIDDEN VALLEY LAKE	STATE: CA	ZIP CODE:	95467
CAPACITY:	14	CENSUS: 0	DATE:	07/05/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Janell Pike		TIME COMPLETED:	01:00 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	An Annual inspection was made to the facility by Licensing Program Analyst (LPA), Chris Arnhold. A review of facility file was conducted in the office and indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently 4 adults living in the home. During today’s inspection the home and grounds were toured. The facility sketch was reviewed and verified. There were no children present during today’s inspection. No children were observed left in any parked vehicle. The facility’s operating hours are 7:15 AM-5:15 PM, Monday - Friday. The childcare area is the entire home with the exception of the master bedroom and bathroom. The backyard is the outdoor childcare area and is fully fenced. There are no bodies of water at the home. The childcare area was at a comfortable indoor temperature. There were safe toys and equipment available for children. There is a working telephone in the home. At approximately 10:30AM, 3 staff record was reviewed; Pediatric CPR and First Aid certifications were reviewed and expire on 02/2021, Immunization and TB results were on file. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be stored out of the reach of children. Licensee stated poisons are locked in an outdoor shed in the off-limits area of the back yard. LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The roster of children in care was reviewed and was current. The licensee has conducted an emergency drill within the past six months and documented on 05/2019. The Licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection. At approximately 11:00AM, 4 children's records were reviewed; current immunization’s and Notification of Parent’s Rights forms were on file. The licensee is not providing Incidental Medical Services (IMS) to children in care.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2019

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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: PIKE, JANELL FCCH	FACILITY NUMBER: 173009037
	VISIT DATE: 07/05/2019

NARRATIVE

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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 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 AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, 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: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2019

LIC809 (FAS) - (06/04)

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