293603556-2-13-2020-03-CC-BMOS-BLRQ5V-20200213105233

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 293603556
Report Date: 02/13/2020
Date Signed: 02/13/2020 10:52:42 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	VAN LIEW, SARAH		FACILITY NUMBER:	293603556
ADMINISTRATOR:	VAN LIEW, SARAH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 477-5772
CITY:	GRASS VALLEY	STATE: CA	ZIP CODE:	95945
CAPACITY:	14	CENSUS: 7	DATE:	02/13/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Sarah Van Liew - Licensee		TIME COMPLETED:	11:00 AM

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	Licensing Program Analyst (LPA) Blake Morillas met with the Licensee, Sarah Van Liew, for the purpose of an unannounced Annual/Random inspection. The Licensee's two Assistants were also present upon arrival. All individuals subject to criminal background review have obtained a criminal record clearance. Today’s census was 1 infant and 6 preschool age children. Operating hours are 7:00am to 5:30pm, Monday through Friday, year around. A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include the Converted Garage and Backyard. Licensee acknowledged that children may never enter these off-limit areas. LPA observed a working phone, fire extinguisher, and functioning smoke and carbon monoxide detectors. Licensee noted that there are weapons in the home. Firearms are stored in their own safe and ammunition is separately stored according to Title 22 Regulations. Toxic and hazardous items (detergents, cleaning compounds, medications, sharp utensils, items that could pose a danger to children in care) are properly stored and inaccessible to children. There is non-operable fireplace at the home that has been sealed to prevent access by children in care. There are stairs in the home which are properly barricaded. Safe toys and play equipment are observed. The outdoor play space is fenced. There are no bodies of water on the premises. *Continued on LIC 809-C

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake Morillas	TELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: VAN LIEW, SARAH	FACILITY NUMBER: 293603556
	VISIT DATE: 02/13/2020

NARRATIVE

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*Continuation of LIC 809

Children’s files were reviewed. A current roster is being maintained. Licensee's fire and disaster drills are conducted and documented. Preventative health training, current pediatric CPR and First Aid certification was verified for the Licensee (expires 2/2021). Mandated Reporter Training (AB 1207) and immunizations for Licensee and Assistants was also verified.

This provider is currently providing IMS services to children in care. Incidental Medical Services (IMS) policy was reviewed.

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 verified the annual fees are current.

LPA provided and discussed the Safe Sleep in Child Care and Lead Testing brochures (AB 2370).

LPA reviewed and discussed this facility evaluation report with the Licensee. LPA provided a Notice of Site Visit and the Licensee acknowledges that this notice should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at http://ccld.ca.gov for child care updates, current forms, legislation and regulation information.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

The Licensee's signature on this form acknowledges receipt of this form.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake Morillas	TELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020

LIC809 (FAS) - (06/04)

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