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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 185406958
Report Date: 05/15/2019
Date Signed: 05/15/2019 12:59:11 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:EIGEN, SALLY FAMILY CHILD CARE HOMEFACILITY NUMBER:
185406958
ADMINISTRATOR:EIGEN, SALLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 640-2034
CITY:SUSANVILLESTATE: CAZIP CODE:
96130
CAPACITY:14CENSUS: 7DATE:
05/15/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Sally EigenTIME COMPLETED:
01:05 PM
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An annual inspection was made to the facility by Licensing Program Analysts (LPAs), Chris Krogstad and Patricia Pacheco. A review of personnel report on 5/15/19 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 two adults living in the home.

During today’s inspection the home and grounds were toured. The licensee was supervising seven children and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 6:15am to 5:15pm, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. There is a dedicated child care room in the lower level of the home. The upstairs is off-limits and inaccessible with a gate at the entrance staircase. The home was clean and orderly. There were 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 09/2019. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) were stored out of the reach of children. Poisons were locked in the garage. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. Firearms are locked. Ammunition is locked separate. Children use a dedicated fully fenced child care yard off the child care room. There is a hot tub on the front porch with a locked cover. There were no pools or any other bodies of water observed. Seven children's records were reviewed at 12:25pm; required emergency information, parent's rights and immunization records were 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 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 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: Christen KrogstadTELEPHONE: (530) 895-4230
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2019
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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