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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313605936
Report Date: 11/08/2019
Date Signed: 11/08/2019 01:40:24 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:GAUTHIER, CHERYLFACILITY NUMBER:
313605936
ADMINISTRATOR:GAUTHIER, CHERYLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 540-8914
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:14CENSUS: 10DATE:
11/08/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Cheryl GauthierTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jeremey McClain met with licensee Cheryl Gauthier for an unannounced annual/random inspection. LPA observed a census of 10 children, which included four infants and six preschool age children. Licensee’s two assistants were present during the inspection. Licensee stated there aren’t new residents in the home. All adult residents currently have criminal record clearances.
LPA toured areas of the home accessible to the children. No changes have been made to the off-limit areas.
LPA observed current CPR/First Aid certificate which expires 07/2021. LPA observed the following posted: a license, a Parents' Rights Poster and an Emergency Disaster Plan. LPA reviewed children's records for completeness, as well as the client roster. Licensee and assistants provided proof of immunizations for MMR, Pertussis, and influenza.
LPA observed that hazardous items (detergents, cleaning compounds, medication, sharp utensils, and other items that could pose a danger to children in care) are properly stored out of children's reach. LPA observed a fire place that was properly screened, and stairs were properly barricaded. There is a working telephone in the home. Licensee stated that there are no weapons in the home. Licensee’s fire extinguisher, carbon monoxide and smoke detector meet regulation. LPA observed fire drills documented on a calendar, indicating that the licensee is conducting disaster drills at least once every 6 months. Toys appear to be safe and in working order. The backyard is fenced. Licensee has a pool that is fenced properly according to regulation.
Incidental Medical Services (IMS) policy was discussed. LPA left an example of a plan of operation. 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
AB1207 Mandated Reporter training was observed to be current. LPA provided Licensee with website: http://childcare.mandatedreporterca.com/ and reminded the licensee that the training must be completed once every two years.
LPA discussed recent changes in licensing requirements, Safe Sleep Regulations Concepts and provided licensee with Provider Information Notice. LPA also provided licensee with CDSS’ AB 2370 brochure regarding the effects of lead exposure. LPA provided the licensee with the Summer 2019 quarterly update from Childcare Advocates.
No deficiencies were issued during today’s inspection.
This report was reviewed with licensee, and an exit interview was conducted. A Notice of Site Visit was provided and should remain posted for 30 days.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019
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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