293605639-7-11-2023-03-CC-MGAO-CTMP59-20230711110021

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 293605639
Report Date: 07/11/2023
Date Signed: 07/11/2023 11:00:30 AM

Document Has Been Signed on 07/11/2023 11:00 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	DOTHEE, TULUM		FACILITY NUMBER:	293605639
ADMINISTRATOR:	DOTHEE, TULUM		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 271-1258
CITY:	ROUGH & READY	STATE: CA	ZIP CODE:	95975
CAPACITY:	14	CENSUS: 8	DATE:	07/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Tulum Dothee		TIME COMPLETED:	11:05 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) Matthew Gallo met with Licensee Tulum Dothee for the purpose of an unannounced required 1-year inspection. Upon arrival at 9:50am, LPA observed a total census of 7 preschool children supervised by 2 staff, with one additional preschool child arriving during the visit for a total census of 8. Licensee's assistant and partner were also present during the inspection. Licensee guided LPA on a tour of the facility, and a health and safety inspection was conducted in all areas accessible to children. Off-limits areas include kitchen, garage, and pool house. Licensee acknowledged that children must never enter these areas. LPA observed the required postings, a working phone, 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors. Per Licensee, there are no weapons in the home. Toxic and hazardous items are inaccessible to children, and poisons are properly locked under key in off-limit area. Open-faced heater is properly fenced to prevent access to children. There are no stairs in the home. There is a pool on the property that is properly barricaded with a 5ft fence that does not obstruct view and features a self-latching gate that opens outward. Outdoor play yard is fenced. All adults present had criminal record clearances, and Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. LPA reviewed 7 children’s files and observed them to be complete. A current roster is being maintained and fire and disaster drills are documented. Current CPR and First Aid certification was verified and expires 8/2023, and AB 1207 Mandated Reporter Training was verified for the Licensee and expires 8/2024. LPA observed employee files to be complete. (Report continues LIC809-C)

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Matthew Gallo	TELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DOTHEE, TULUM	FACILITY NUMBER: 293605639
	VISIT DATE: 07/11/2023

NARRATIVE

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Licensee does not enroll infants. In the case this policy is reconsidered, LPA referenced the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as a resource for information on Safe Sleep regulations. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. When any IMS is provided an updated Plan of Operation that includes 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]

No deficiencies were cited during today’s inspection.

Exit interview conducted and report was reviewed with the licensee Tulum Dothee. Appeal rights and a notice of site visit were provided, the latter of which must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Matthew Gallo	TELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC809 (FAS) - (06/04)

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