313623635-8-5-2020-03-CC-LHAM-BS7TUB-20200805150205

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313623635
Report Date: 08/05/2020
Date Signed: 08/05/2020 03:02:44 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:	KOBLE-PROTHERO, REBECKA		FACILITY NUMBER:	313623635
ADMINISTRATOR:	KOBLE-PROTHERO, REBECKA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 863-0024
CITY:	AUBURN	STATE: CA	ZIP CODE:	95603
CAPACITY:	14	CENSUS: 0	DATE:	08/05/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Rebecka Koble-Prothero		TIME COMPLETED:	02:00 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	Due to COVID-19 LPA Habtom was unable to complete the change of location based on normal practice of an announced inspection. LPA Habtom conducted a televisit using google duo on August 5, 2020 at 1:40 pm with the licensee Rebecka Koble-Prothero. Facility has moved from the previously licensed facility located at 1470 Wimbledon Dr., Auburn,CA 95602 facility #313622196. No children present at time of visit. A tour of the home, inside and outside, as shown on the facility sketch was conducted. There were no "bodies of water" observed at the 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 meet regulations. Stairs were barricaded with a gate. Safe toys and play equipment are observed. There is a working telephone. All adults who reside or work in the home have a criminal record clearance or exemption. LPA explained that any new residents that move into the home must be fingerprint cleared and the Licenisng Agency must be notified. There are no excluded individuals present at this home. Pediatric CPR/FA is current with expiration date of 7/2022. Mandated reporter training verified with an expiration date of 7/2022. Licensee was made aware mandated reporter training is to be renewed every two years at mandatedreporterca.com free of charge. A child roster is maintained. Fire and disaster drills were discussed and are to be conducted every six months and documented. LPA Blesi discussed SB 277 (public health vaccination) and SB 792 (day care facilities: Immunization exemptions) with licensee at time of visit. Report continued on 809-C

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea Habtom	TELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2020

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: KOBLE-PROTHERO, REBECKA	FACILITY NUMBER: 313623635
	VISIT DATE: 08/05/2020

NARRATIVE

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Off-limit rooms are: downstairs bedroom, all of second floor, second and third level of backyard. 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-5:30 pm Monday thru Friday and other hours as arranged. Licensee states she does not transport children.

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

Effective today 8/5/2020 applicant is licensed to serve up to either 14 children, two (2) of which must be at least 6 years of age and no more than three (3) may be infants; or 12 children, four (4) of which may be infants. Infants are children under the age of 2 years.

The licensees will begin operating their family child care home at this location. LPA advised that the old facility number will be closed as of this date and she is no longer able to operate in that location.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea Habtom	TELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2020

LIC809 (FAS) - (06/04)

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