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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623638
Report Date: 06/09/2021
Date Signed: 06/09/2021 12:18:24 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: 8DATE:
06/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Jennifer Rutherford - LicenseeTIME COMPLETED:
12:40 PM
NARRATIVE
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On Wednesday, June 9th, 2021, at 11:10am, Licensing Program Analyst (LPA) Blake Morillas met with the Licensee, Jennifer Rutherford, for the purpose of an Annual Required inspection. The Licensee's helper and teenage daughter was also present upon arrival. All individuals subject to criminal background review have obtained a criminal record clearance. At 11:16am, 2 infants and 6 preschool age children were observed.

Operating hours are 7:30am to 3:30pm, Monday through Friday.

At 11:17am, LPA initiated a health and safety inspection of all areas accessible to children. Off-limits areas include the Entire Upstairs, Outbuildings, and Garage. Licensee acknowledged that children may never enter these off-limit areas.

LPA observed a working phone, fire extinguisher, and functioning smoke and carbon monoxide detectors.

Licensee stated there are no weapons in the home.

Toxic and hazardous items (detergents, cleaning compounds, medications, sharp utensils, items that could pose a danger to children in care) are properly stored and inaccessible to children.

There is no fireplace in the areas where the children are present. There are stairs in the home which are properly barricaded.

Safe toys and play equipment are observed.

*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: 06/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021
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: RUTHERFORD, JENNIFER
FACILITY NUMBER: 313623638
VISIT DATE: 06/09/2021
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*Continuation of LIC 809

The outdoor play space is fenced. The Licensee understands that in unfenced outdoor areas, 100% supervision of children is required.

There are no bodies of water on the premises.

At 11:40am, LPA began to review Children’s files and other documentation. A current roster is being maintained. Licensee's fire and disaster drills are conducted and documented. Preventative health training, current pediatric CPR and First Aid certification was verified for the Licensee (expires 3/2023). Mandated Reporter Training (AB 1207) for Licensee and Helper was also verified.

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes 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 for TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the Americans with Disabilities Act, available at: http://www.ada.gov/childqanda.htm

LPA discussed the Safe Sleep in Child Care and current Covid-19 guidelines for Placer County.

Licensee was encouraged to visit the Department website at http://ccld.ca.gov for child care updates, current forms, legislation and regulation information.



In the areas that were evaluated, there were no deficiencies at this time.

At 12:10pm, LPA reviewed and discussed this facility evaluation report with the Licensee.



LPA provided a Notice of Site Visit and the Licensee acknowledges that this notice shall remain posted for 30 days for parental review.

The Licensee's signature on this form acknowledges receipt of this form.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021
LIC809 (FAS) - (06/04)
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