313617353-11-29-2021-03-CC-KOWS-C98RRG-20211129121503

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313617353
Report Date: 11/29/2021
Date Signed: 11/29/2021 12:15:11 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:	NELSON, LAILOMA		FACILITY NUMBER:	313617353
ADMINISTRATOR:	NELSON, LAILOMA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 425-4502
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY:	14	CENSUS: 9	DATE:	11/29/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Lailoma Nelson - Licensee		TIME COMPLETED:	12:30 PM

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	An unannounced annual/random inspection is made today by LPA Katrina Owens. Present at time of inspection were licensee, her husband and 9 day care children. Ages of children present were 1,4,1,2,3,3,3,4,and 2 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. There is no fireplace. Fire extinguisher, Carbon Monoxide Detector and Smoke Detector meets regulations. Currently, licensee does have 1 dog that is inaccessible to children; dog is kept in off limit area. Stairs are barricaded when children under age 5 years old are present. Toys and play equipment that were observed appear to be safe. There is a working telephone. Adequate supervision is being provided during this inspection. Licensee understands children must be supervised when outside in any unfenced play area. No infants under 12 months old present; no sleeping plans reviewed. Licensee will do 15 minute check log document. LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. 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. Continued on next page.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021

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: NELSON, LAILOMA	FACILITY NUMBER: 313617353
	VISIT DATE: 11/29/2021

NARRATIVE

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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. Licensee, Lailoma Nelson, 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.

Pediatric CPR/FA is current with expiration date of 3/2023. 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 observed that all staff has completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com

LPA discussed with licensee the Effects of Lead Exposure brochure.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Off-limit rooms are: Entire upstairs and Garage. Licensee acknowledges that children may never enter these off-limit areas. Swing set observed and is anchored into ground. During the exit interview, LPA discussed AB 633, Parent Notification Requirements, and the posting of licensing inspection notices and reports. Hours of operation are 7:45 AM to 4:30 PM; Monday thru Friday and other hours as arranged. Licensee states she does not transport children. Continued on next page.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021

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: NELSON, LAILOMA	FACILITY NUMBER: 313617353
	VISIT DATE: 11/29/2021

NARRATIVE

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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, NO deficiencies are observed today.
Exit interview conducted and report was reviewed with the licensee, Lailoma Nelson.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

A notice of site visit was given and must remain 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: 11/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021

LIC809 (FAS) - (06/04)

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