283009308-11-6-2019-01-CC-KOCL-BHNRJY-20191106120443

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 283009308
Report Date: 11/06/2019
Date Signed: 11/06/2019 12:04:49 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:	MONERO, KIMBERLEE FCCH		FACILITY NUMBER:	283009308
ADMINISTRATOR:	MONERO, KIMBERLEE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 654-8164
CITY:	AMERICAN CANYON	STATE: CA	ZIP CODE:	94503
CAPACITY:	14	CENSUS: 8	DATE:	11/06/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Kimberlee Monero		TIME COMPLETED:	12:20 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 11/6/19 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 3 adults living in the home. During today’s inspection the home and grounds were toured with the licensee at 10:45am. Operating hours are 7:00am to 5:30pm, Monday- Friday. Today, the Licensee and her daughter/ assistant were supervising 3 infants and 5 preschool children. Capacity & ratio are met. The floor plan was verified. The off-limits areas were inaccessible. There is a baby gate at the base of the stairs to prevent access to the second story. The garage is used for additional care. The fireplace is barricaded. Licensee states that there are no poisons but can lock them in the backyard shed. The back yard is used by children for outdoor play and is completely fenced. 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 (10/16/19). Pediatric CPR and First Aid certifications were current and expire 03/12/2020.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

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,
, CA

FACILITY NAME: MONERO, KIMBERLEE FCCH	FACILITY NUMBER: 283009308
	VISIT DATE: 11/06/2019

NARRATIVE

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Licensee stated that there were no bodies of water on the premises and none were observed. 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 11:10am for Immunizations and signed Notification of Parent’s Rights forms, all were current. Two staff files were reviewed at 11:20am. 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. 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: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

LIC809 (FAS) - (06/04)

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