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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620281
Report Date: 11/07/2019
Date Signed: 11/07/2019 01:38:03 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:KEIZER, MARISOLFACILITY NUMBER:
313620281
ADMINISTRATOR:KEIZER, MARISOLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 749-4266
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:14CENSUS: 11DATE:
11/07/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Marisol Keizer - LicenseeTIME COMPLETED:
01:45 PM
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 Daisy Guzman and 11 day care children. Ages of children present were 2,4,2,3,3,1,3,4,4,4 and 1 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. Licensee states there are no weapons or firearms in the home. There is a fountain in front of home / walkway that is not a drowning hazard. Swimming pool is fenced per regulation. LPA informed licensee the mesh pool fencing must to be in place anytime day care children are present. LPA observed poisons, cleaning compound's, medications and other hazardous items are inaccessible to children. Fireplace contains a screen and is inaccessible to children. Fire extinguisher, Carbon Monoxide Detector and Smoke Detector meets regulations. There are no pets observed today. 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. The backyard is completely fenced. Licensee was reminded children are to be supervised 100% of the time whenever outside in the unfenced play area. Licensee used the detached garage for a playroom for children.; LPA observed no hazards.

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 7/20/2021. A child roster is maintained. Fire and disaster drills are conducted every six months and documented. Staff and children records reviewed.
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SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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: KEIZER, MARISOL
FACILITY NUMBER: 313620281
VISIT DATE: 11/07/2019
NARRATIVE
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LPA observed proof that licensee and staff/ volunteers have met the requirements of SB 792.

LPA did not observed that all staff has completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com

LPA discussed the new Safe Sleep in Child Care regulation and gave licensee the brochure. LPA discussed and gave licensee the Effects of Lead Exposure brochure.

This facility is not providing Incidental Medical Services-IMS at this time. LPA discussed IMS services and the requirement to create a plan of operation. Specifics on the plan can be found in the family child care home evaluator manual (FCCH EM) Policy 102417.



Off-limit rooms are: Entire upstairs, Laundry room, Master bedroom / bathroom and attached Garage. Licensee acknowledges that children may never enter these off-limit areas. During the exit interview, LPA discussed AB 633, Parent Notification Requirements, and the posting of licensing inspection notices and reports. Hours of operation are 7:30 AM to 5:00 PM; 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 PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: KEIZER, MARISOL
FACILITY NUMBER: 313620281
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/09/2019
Section Cited

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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 provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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This requirement was not met by licensee and her assistant has not completed the required mandated reporter training. This is a potential risk to children.
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Licensee was informed if deficiency is not corrected by due date a civil penalty may be assessed.

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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 PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2019
LIC809 (FAS) - (06/04)
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