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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313622314
Report Date: 05/02/2019
Date Signed: 05/02/2019 11:35:22 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:SCHAEFER, KACYFACILITY NUMBER:
313622314
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
05/02/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Kacy SchaeferTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Amie Randa met with licensee, Kacy Schaefer for the purpose of an unannounced Annual Random Inspection and a Capacity Increase Inception. The licensee is requesting a capacity for a Large Family Child Care Home; LPA received the Fire Clearance from the Auburn Fire District. Upon arrival today's census was three infants and two preschool aged children. Also present in the home was the licensee's husband; all individuals subject to criminal background review have obtained a criminal record clearance. The facility operates Monday-Friday 6:30AM-5;30PM. Licensee understands she must be present 80% of operating hours and must submit a change of location application if she relocates.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas consist of the garage and side yard LPA observed a working phone, 2A10BC fire extinguisher, functioning smoke and carbon monoxide detectors. LPA observed a locked gun safe and the ammo was stored separately. Toxic and hazardous items; such as cleaning compounds and medications are inaccessible to children. Outdoor play space is fully fenced; the licensee understands that children need 100% supervision is required in unfenced areas. LPA did not observe any bodies of water.

Children’s files were reviewed. A current roster is being maintained and fire and disaster drills are documented. Preventative health training, current pediatric CPR and first aid certification was verified and expires on (01/2020).

LPA reviewed the licensee on the new regulation AB 1207- California Child Care Worker: Mandated Reporter Training. The licensee must complete the training every two years starting January 1, 2018 and retain proof of completion in the facility file. The training can be could at: mandatedreporterca.com. LPA observed proof of completion.

LPA also discussed the Smoking Probation Regulation (AB 1819-Smoking Prohibition), the Nutritious Beverage Act and the Incidental Medical Services (IMS) policies with the licensee. LPA discussed the new Immunization Regulations SB 792, and the licensee has proof of immunizations
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amie RandaTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: SCHAEFER, KACY
FACILITY NUMBER: 313622314
VISIT DATE: 05/02/2019
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This provider is currently not providing IMS services to children in care. 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.

LPA advised the licensee on Safe Sleep Practices and SIDS; the licensee stated they are understood and practiced. She stated she uses porta cribs for sleeping infants and understand infants cannot sleep in car seats, swings or other items not intended for sleeping.

LPA verified the annual fees are current. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the licensee can request to be added to the distribution list to receive Quarterly Updates.

This facility evaluation report was reviewed and discussed with the licensee. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form. In the areas that were evaluated, no deficiencies were observed at the time of the inspection.



As of today 05/02/2019 licensee is approved for a Large Family Child Care Home; to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years old. Licensee understand her two young children are included in the ratio and an assistant must be present when more than eight children are present.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amie RandaTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2