283000179-1-13-2020-01-CC-KOCL-BKSRRP-20200113121528

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 283000179
Report Date: 01/13/2020
Date Signed: 01/13/2020 12:15:35 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME:	DALEN, TAMI FAMILY CHILD CARE HOME		FACILITY NUMBER:	283000179
ADMINISTRATOR:	DALEN, TAMI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 258-8368
CITY:	NAPA	STATE: CA	ZIP CODE:	94558
CAPACITY:	14	CENSUS: 10	DATE:	01/13/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Tami Dalen		TIME COMPLETED:	12:30 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) Kevin O'Connell. A review of staff records on 01/13/2020 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 2 adults living in the home. During today’s inspection the home and grounds were toured with the licensee at 11:05am. Operating hours are 7:30am to 5:30pm, Monday- Friday. Today, the Licensee and assistant were supervising 10 preschool children. Capacity & ratio are met. The floor plan was verified. The off-limits areas (upstairs) were inaccessible with a gate at the base of the stairs. The fireplace is screened and zip tied shut. Poisons are locked in the outdoor shed. The back yard is used by children for outdoor play and is completely fenced. There is a pool in the back yard that is fenced per regulation and has a cover that supports the weight of an adult per regulation. There is also a hot tub that is covered and locked. The home was observed to be clean and orderly, and was at a comfortable indoor temperature. There were safe toys and equipment available for children. There is a working telephone in the home. 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. The LPA observed a working smoke detector, carbon monoxide detector and a charged fire extinguisher rated at least 2A:10-BC. The roster of children in care was reviewed and was current and a fire disaster drill was conducted within the past six months (12/19). CPR and First Aid certifications were current and expire 02/2020.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2020

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: DALEN, TAMI FAMILY CHILD CARE HOME	FACILITY NUMBER: 283000179
	VISIT DATE: 01/13/2020

NARRATIVE

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The Licensee stated that there are no guns or dangerous weapons on the premises and none were observed.
Eight children's records were reviewed at 11:40AM for Immunizations and signed Notification of Parent’s Rights forms, all were current. Two staff files were reviewed at 11:30AM. Immunizations and Mandated Reporter Training certificates were current.
The Incidental Medical Services (IMS) policy was discussed with the licensee. The licensee is not providing Incidental Medical Services (IMS) to children in care at this time as there is not a need. 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 is 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, Safe Sleep in Childcare brochure, What does a Safe Sleep Environment Look Like brochure & Safe Sleep Concepts handout, were reviewed and discussed with the licensee. The Effects of Lead Exposure brochure has been reviewed with and discussed with the licensee.

All licensing reports are public information and must be made available upon request for at least three years. No deficiencies were cited today.
Notice of Site Visit shall be posted for 30 days from today's visit.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2020

LIC809 (FAS) - (06/04)

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