313623261-8-4-2021-03-CC-KOWS-C5KSMM-20210804140009

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313623261
Report Date: 08/04/2021
Date Signed: 08/04/2021 02:00:16 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, TAMARA		FACILITY NUMBER:	313623261
ADMINISTRATOR:	NELSON, TAMARA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 217-6154
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY:	14	CENSUS: 10	DATE:	08/04/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:17 PM
MET WITH:	Tamara Nelson - Licensee		TIME COMPLETED:	02:30 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 and 10 day care children. Ages of children present were 2,1,5,5,2,2,4,2,1 and 4 years old. Licensee is not a Foster Parent, nor have any other licenses. A tour of the home, inside and outside, as shown on the facility sketch is conducted. Staff and Children were spoken to during inspection Swimming pool is fenced per regulation. LPA reminded licensee the mesh pool fencing needs to be in place at all times when day care children are present. Firearms and ammunition are properly stored according to Title -22 Regulations. 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. Currently, licensee does have 1 dog that is inaccessible to children. 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 any unfenced play area. LPA discussed sleeping plan for each infant under 12 months old present. No infants under 12 months old present; no sleeping plans reviewed. LPA discussed 15 minute check log document. 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 6/2023. A child roster is maintained. Fire and disaster drills are conducted every six months and documented. Some children records reviewed.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

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, TAMARA	FACILITY NUMBER: 313623261
	VISIT DATE: 08/04/2021

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 discussed the new Safe Sleep in Child Care regulation. LPA discussed 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: Master bathroom and 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 7:00 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, NO deficiencies are observed today. This report was reviewed and discussed
with licensee at time of inspection. Licensee have read and understands the content of this report.

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: 08/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

LIC809 (FAS) - (06/04)

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