313623261-9-25-2019-03-CC-KOWS-BGCMVD-20190925095634

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313623261
Report Date: 09/25/2019
Date Signed: 09/25/2019 09:56:40 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:	NELSON, TAMARA		FACILITY NUMBER:	313623261
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	09/25/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Tamara Nelson - Applicant		TIME COMPLETED:	10:00 AM

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	Licensing Program Analysts (LPA) Katrina Owens met with applicant for a pre licensing inspection. LPA toured the home inside and out, and reviewed forms for children's records. LPA explained about obtaining $300,000 liability insurance. Applicant has a liability policy. Applicant has certificates of completion for 15 hours of health and safety training including CPR and First Aid with expiration date of 7/2021. All adult residents received criminal record clearances. LPA reminded applicant of the applicable Civil Penalty per person for those adults including your own child who have not received fingerprint clearances, are not associated to the license, come in contact with and or provide care and supervision to the children. LPA has provided the Applicant with the web site to enable access to all updated forms, requirements and changes. Applicant understands that she needs to notify licensing for any modification inside and out of the home. Off-limit areas include Master bedroom and Garage. Applicant understands that children may never enter these off-limit areas. LPA reviewed the fire drill requirements. The fire place contains a screen. Fire extinguisher, carbon monoxide detector and smoke detectors meet regulation. Firearms are stored according to Title 22 Regulations. Hazardous cleaning compounds are inaccessible to children. Sharp utensils and Medications are inaccessible to children. The backyard is fenced. Applicant understands that 100% supervision is required in any unfenced areas. There is pool on the premises and the fencing around the pool meets Title 22, Division 12, Chapter 3 Regulations with a self closing, self latching gate that swings away from the pool . Applicant understands the mesh pool fencing has to be in place during day care hours. Applicant will supervise day care children at all times. Family pets are inaccessible to family day care children. There are no stairs at the home. Planned hours of operation are Monday through Friday, 6:30 am to 5:30 pm and other hours as arranged. 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: 09/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

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: NELSON, TAMARA	FACILITY NUMBER: 313623261
	VISIT DATE: 09/25/2019

NARRATIVE

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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 provided the Community Care Licensing’s 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.

Effective today 9/25/19, applicant is license to serve up to either 8 children, two (2) of which must be at least 6 years of age and no more than two (2) may be infants; or 6 children, three (3) of which may be infants; or 4 infants only. Infants are children under the age of 2 years.

Exit Interview were conducted.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

LIC809 (FAS) - (06/04)

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