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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 185403612
Report Date: 03/06/2020
Date Signed: 03/06/2020 12:38:55 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:SALEM, DOROTHY FAMILY CHILD CARE HOMEFACILITY NUMBER:
185403612
ADMINISTRATOR:SALEM, DOROTHYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 253-3317
CITY:JANESVILLESTATE: CAZIP CODE:
96114
CAPACITY:14CENSUS: 10DATE:
03/06/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Dorothy SalemTIME COMPLETED:
12:50 PM
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On 3/6/2020 a11:50am, a required one year inspection was made to the facility by Licensing Program Analyst (LPA), Emilia Grisak. A review of staff records on 3/6/20 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 three adults living in the home.
At 12:05pm the home was toured inside and outside. The licensee and an assistant were supervising ten children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are 5:30am to 6pm, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limit areas of the home are the lower level and upstairs master bedroom were made inaccessible by a gate at the stairway and a door knob cover. 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 on 11/2020. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. Poisons are locked in a detached garage. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection. The children use the back yard as the outdoor play area and it is not fully fenced at this time as new fencing is being installed. Licensee understands that constant visual supervision must be provided while children are outside. There were no pools or other bodies of water observed in the yard. Ten children's records were reviewed at 12:25pm; required emergency information was observed to be on file. The licensee is not providing Incidental Medical Services to children in care.
The following information regarding the Americans with Disabilities Act (ADA) was provided: US DOJ toll-free ADA Info 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 Association 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 VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Emilia GrisakTELEPHONE: (530) 895-5821
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
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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