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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293605175
Report Date: 01/07/2020
Date Signed: 01/07/2020 02:53:42 PM

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:ROHDE, KARENFACILITY NUMBER:
293605175
ADMINISTRATOR:ROHDE, KARENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 274-1734
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95945
CAPACITY:14CENSUS: 10DATE:
01/07/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Kayla Rohde - AssistantTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Blake Morillas met with the Licensee's Assistant, Kayla Rohde, for the purpose of an unannounced Annual/Random inspection. The Licensee's other Assistant, Cami Day, was also present upon arrival. All individuals subject to criminal background review have obtained a criminal record clearance. Today’s census was 2 infants and 8 preschool age children.

Operating hours are 7:00am to 5:30pm, Monday through Friday.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include the Master Bedroom, Upstairs, Kitchen, Living Room, Office/Laundry, Backyard, Garage. Assistants acknowledged that children may never enter these off-limit areas.

LPA observed a working phone, fire extinguisher, and functioning smoke and carbon monoxide detectors.

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. The fireplace in the home is located in an off limits area and is inaccessible to children in care. There are stairs in the home which are properly barricaded. Safe toys and play equipment are observed.

There is a pool at the home. The swimming pool in the backyard is fenced with a self-latching and self-closing gate. The outdoor play space is fenced.

*Continued on LIC 809-C
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020
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: ROHDE, KAREN
FACILITY NUMBER: 293605175
VISIT DATE: 01/07/2020
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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 Assistants (both expiring in 8/2021). Mandated Reporter Training (AB 1207) for the Assistants was also verified.

This provider is currently not providing IMS services to children in care. Incidental Medical Services (IMS) policy was discussed. 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 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 Assistant's signature on this form acknowledges receipt of this form.

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020
LIC809 (FAS) - (06/04)
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