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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293623327
Report Date: 10/22/2021
Date Signed: 10/22/2021 03:03:03 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:GRANHOLM, KATHLEENFACILITY NUMBER:
293623327
ADMINISTRATOR:GRANHOLM, KATHLEEN & GRANHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 362-2846
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95945
CAPACITY:14CENSUS: 2DATE:
10/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Kathleen Granholm - LicenseeTIME COMPLETED:
03:15 PM
NARRATIVE
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On Friday, October 22nd, 2021, at 1:28pm, Licensing Program Analyst (LPA) Blake Morillas met with the Licensee, Kathleen Granholm, for the purpose of an unannounced Annual Required inspection. All individuals subject to criminal background review have obtained a criminal record clearance. At 1:28pm, 2 preschool age children were observed.

Operating hours are 9:00am to 5:30pm, Monday through Friday, year around.

At 1:37pm, LPA initiated a health and safety inspection of all areas accessible to children. Off-limits areas include the Backyard Deck. 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.

The fireplaces in the home are appropriately barricaded to prevent access by children. There are stairs in the home which are properly barricaded. Safe toys and play equipment are observed.

*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: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
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: GRANHOLM, KATHLEEN
FACILITY NUMBER: 293623327
VISIT DATE: 10/22/2021
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*Continuation of LIC 809

The outdoor play space is fenced. The Licensee understands that in unfenced outdoor areas, 100% supervision of children is required.

There is a seasonal pond at the home located at the back of a goat pasture on the property. The pasture is fenced and the dedicated play yard is also completely fenced, with a self latching/self closing gate providing access to the fenced play yard.

At 2:05pm, LPA began to review Children’s files and other documentation. 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 10/2021). The Licensee was reminded that her CPR/First Aid is about to expire and that due to Covid-19, "hybrid" (a combination of in-person and online training) CPR/First Aid classes are being accepted.

Incidental Medical Services (IMS) policy was discussed. 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 for TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the Americans with Disabilities Act, available at: http://www.ada.gov/childqanda.htm

LPA provided and discussed the Safe Sleep in Child Care regulations as well as current Covid-19 guidelines.

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, there were no deficiencies at this time.

At 2:56pm, 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 shall remain posted for 30 days for parental review.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
LIC809 (FAS) - (06/04)
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