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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623638
Report Date: 07/20/2020
Date Signed: 07/20/2020 01:52:05 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:RUTHERFORD, JENNIFERFACILITY NUMBER:
313623638
ADMINISTRATOR:RUTHERFORD, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 906-9576
CITY:FORESTHILLSTATE: CAZIP CODE:
95631
CAPACITY:14CENSUS: 0DATE:
07/20/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Jennifer RutherfordTIME COMPLETED:
02:00 PM
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*NOTE: Due to Covid-19 and DPH guidelines on social distancing, a Tele-inspection was conducted via FaceTime.*

On Monday, July 20th, 2020, at 1:10pm, Licensing Program Analyst (LPA) Blake Morillas met with the Licensee, Jennifer Rutherford, for a Prelicensing - Change of Location inspection. The Licensee moved across town to this location. This is a 2 story, 3 bedroom, 3 bathroom home.

The anticipated operating hours are 7:30am to 3:30pm, Monday through Friday, year around.

At 1:15pm, LPA initiated a health and safety inspection of all areas of the home as well as the outdoor area that will be used by the children in care.

Off-limits areas will include the Entire 2nd Floor, Outbuildings, and Garage. Licensee acknowledged that children may never enter these off-limit areas.

Fire extinguisher, carbon monoxide and smoke detectors meet regulation. Hazardous cleaning compounds and medications are stored inaccessible and out of children reach. The Licensee stated there are no weapons in the home. Stairs in the home are gated to prevent access by children in care. There is a wall heater in the downstairs of the home that is not hooked up or in use at this time. The Licensee understands that when in use, it must be barricaded to prevent access by children in care.

The outdoor area used by children at this time is partially fenced and age appropriate toys were observed. The Licensee understands that 100% supervision is required in any unfenced areas. There are no bodies of water on the premises. *Continued on LIC 809-C
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2020
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: RUTHERFORD, JENNIFER
FACILITY NUMBER: 313623638
VISIT DATE: 07/20/2020
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*Continuation of LIC 809

At 1:32pm, LPA began to review files and other documentation that is required for operation of a day care. The LPA reviewed the fire drill requirements. LPA discussed the Safe Sleep in Child Care and Lead Testing brochures (AB 2370). At this time, the Licensee does not carry liability insurance. LPA explained about obtaining a $300,000 annual aggregate/$100,000 per occurrence liability insurance policy. Licensee understands that until a policy is obtained, they must use the affidavit.

All adult residents received criminal record clearances. LPA reminded the Licensee of the applicable Civil Penalty per person for those adults, including your own children, who have not received fingerprint clearances.

Licensee has certificates of completion for Preventative Health and Safety training including CPR/First Aid (expires: 3/2021) and Mandated Reporter Training (expires: 9/2020). Licensee was reminded that their Mandated Reporter Training would need to be renewed soon.

Incidental Medical Services (IMS) policy was discussed. 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 are available online (www.ada.gov/childqanda.htm). Applicant was encouraged to visit the Department website (ccld.ca.gov) for child care updates, current forms, legislation and regulation information. LPA advised the Applicant of their responsibility to stay current with the requirements of the Department.

At 1:40pm, LPA reviewed and discussed this facility evaluation report with the Licensee.



Effective today (7-20-2020) the facility is LICENSED to serve a MAX. CAP: 6 - NO MORE THAN 3 INFANTS OR 4 INFANTS ONLY. CAP 8 - NO MORE THAN 2 INFANTS, 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

This report and a Notice of Site Visit will be delivered to the Licensee electronically. Acknowledgement of delivery will constitute acknowledgement of the report in lieu of a signature.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2020
LIC809 (FAS) - (06/04)
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