313617287-9-23-2019-03-CC-KOWS-BGAP5P-20190923110103

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313617287
Report Date: 09/23/2019
Date Signed: 09/23/2019 11:01:11 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:	GRANT, KIMBERLY Y.		FACILITY NUMBER:	313617287
ADMINISTRATOR:	GRANT, KIMBERLY Y.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 780-4769
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY:	14	CENSUS: 9	DATE:	09/23/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Kimberly Grant- Licensee		TIME COMPLETED:	11:00 AM

NARRATIVE

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An unannounced annual/random inspection is made today by LPA Katrina Owens. Present at time of inspection were licensee, her assistant and 9 day care children. Ages of children present were 4,4,4,4,4,4,4,4 and 4 years old.

A tour of the home, inside and outside, as shown on the facility sketch is conducted. Staff and Children were spoken to during inspection. There are no "bodies of water" at this home. Licensee states there are no weapons or firearms in the home. LPA observed poisons, cleaning compound's, medications and other hazardous items are inaccessible to children. Fireplace is blocked and is inaccessible to children. Fire extinguisher and Smoke Detector meets regulations. There are no pets observed today. There are no stairs in the home. Toys and play equipment that were observed appear to be safe. There is a working telephone. Adequate supervision is being provided during this inspection. Children are supervised when outside in the unfenced play area.

The capacity as specified on the license is being maintained. Staff-child ratios are maintained. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Pediatric CPR/FA is current with expiration date of 2/2021. A child roster is maintained. Fire and disaster drills are conducted every six months and documented. Some staff and children records reviewed.
LPA observed proof that licensee and staff/ volunteers have met the requirements of SB 792.

LPA discussed the required mandated reporter training to be taken at website: www.mandatedreporterca.com.

Continued on page 2

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019

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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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: GRANT, KIMBERLY Y.	FACILITY NUMBER: 313617287
	VISIT DATE: 09/23/2019

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LPA discussed the new Safe Sleep in Child Care regulation and gave licensee the brochure.

Off-limit rooms are: Master bedroom and side yard. Licensee acknowledges that children may never enter these off-limit areas. Swing set observed and is anchored into ground. Observed tool shed in backyard and it locked. During the exit interview, LPA discussed AB 633, Parent Notification Requirements, and the posting of licensing inspection notices and reports. Hours of operation are 9:00 AM to Noon; Monday thru Friday and other hours as arranged. Licensee states she does not transport children.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found:
(see next page 809-D) Appeal rights provided to licensee.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019

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: GRANT, KIMBERLY Y.	FACILITY NUMBER: 313617287
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/23/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/23/2019 Section Cited	1 2 3 4 5 6 7	Carbon monoxide detectors: Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12.
	8 9 10 11 12 13 14	This requirement is not met as evidence by facility did not have a carbon monoxide detector. This is a potential risk to children.	8 9 10 11 12 13 14
Type B 10/23/2019 Section Cited	1 2 3 4 5 6 7	On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training
	8 9 10 11 12 13 14	This requirement is not met as evidence by no staff has completed the required mandated reporter training. This is a potential risk to children.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019

LIC809 (FAS) - (06/04)

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