200407821-9-5-2019-04-CC-CROZ-BFQT98-20190905143130

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 200407821
Report Date: 09/05/2019
Date Signed: 09/05/2019 02:31:43 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	CAROL POTTER FAMILY DAY CARE		FACILITY NUMBER:	200407821
ADMINISTRATOR:	POTTER, CAROL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 683-3403
CITY:	COARSEGOLD	STATE: CA	ZIP CODE:	93614
CAPACITY:	14	CENSUS: 1	DATE:	09/05/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Carol Potter		TIME COMPLETED:	03:00 PM

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Licensing Program Analysts (LPAs), Candis Rodriguez and Theresa Marquez, conducted an unannounced annual inspection. LPAs were greeted by Licensee Carol Potter who accompanied LPAs on a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. Present during today’s inspection was one child. One pet was observed during today’s visit; licensee is aware of the safety of children around animals. There are no "bodies of water" in this home. Licensee stated there are no firearms in this home. No poisons were observed on the premises. Cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace is inaccessible to children by a protective screen. There are two working fire extinguishers. Smoke detectors were tested and in working order. The home has adequate heating and ventilation for safety and comfort. There are no stairs in the home.

There is a working telephone that was verified. Adequate supervision is being provided during this visit. Children are supervised when outside in the unfenced play area. Capacity as specified on the license is being maintained. Licensee has a current roster of the children. Licensee maintains documentation of immunizations for the children. Licensee maintains documentation of immunizations for herself and staff. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Licensee is aware that children are never to be left in parked vehicles.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care.

(Continued on LIC 809-C)

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis Rodriguez	TELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CAROL POTTER FAMILY DAY CARE	FACILITY NUMBER: 200407821
	VISIT DATE: 09/05/2019

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Pediatric CPR/First Aid are current expiring in 02/2021. Mandated Reporter Training is current and expires 09/2019. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advanced notice. Days and hours of operation are Monday – Friday; 6:00 AM – 6:00 PM.

LPA discussed Incidental Medical Services (IMS) and left the Plan for Providing Incidental Medical Services (IMS) – FCCH Requirements. 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 (USDOJ) 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, available at: http://www.ada.gov/childqanda.htm.

LPA & licensee discussed the Community Care Licensing website and Mandated Reporter Training: LPA and licensee discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN. LPA thoroughly discussed safe sleep practices and left a copy of A Child Care Provider’s Guide to Safe Sleep.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies were cited.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis Rodriguez	TELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019

LIC809 (FAS) - (06/04)

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