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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617929
Report Date: 03/28/2022
Date Signed: 03/28/2022 11:34:04 AM


Document Has Been Signed on 03/28/2022 11:34 AM - It Cannot Be Edited

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:HOLUB, JANETFACILITY NUMBER:
343617929
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
03/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Janet HolubTIME COMPLETED:
11:45 AM
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At 9:15 a.m. on March 28th, 2022, Licensing Program Analyst (LPA) Karyn Guerra met with Licensee, Janet Holub, for the purpose of an unannounced required - 1 year inspection. No children were present at the facility during time of inspection. Hours of operation are 8:00 a.m.- 4:30 p.m. Licensee has also requested a capacity increase to a large family child care home. A fire clearance is on file with the department. Per the fire clearance, child care must not take place in the converted garage.

All individuals subject to criminal background review have obtained a criminal record clearance. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A health and safety inspection was conducted in all areas accessible to children. LPA observed the required postings, a working phone, 2A10BC fire extinguisher, and functioning combination smoke and carbon monoxide detector. Weapons in the home are appropriately stored. Licensee stated there are not any poisons in the home. Toxic and hazardous items were appropriately stored, inaccessible to children. Front and back outdoor play spaces are fenced. A current roster is maintained. Fire Drills have been conducted and documented.

LPA reviewed children and facility files and observed required documents including consent for emergency medical treatment, emergency information card, and immunization records. Current in person EMSA CPR and First Aid certification was verified and expires June 12th, 2022, and AB 1207 Mandated Reporter Training was verified and expires March 2022. Licensee was reminded to renew mandated reporter training at www.mandatedreporterca.com.

report continued on 809-C.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


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: HOLUB, JANET
FACILITY NUMBER: 343617929
VISIT DATE: 03/28/2022
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Licensee stated that they are not currently providing infant care. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This provider is not currently providing Incidental Medical Services IMS services to children in care. IMS policy was discussed. Licensee stated that no children in care require medications. 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: https://www.ada.gov/childqanda.htm.
A staff interview was conducted. The department's inspection authority was discussed.
Annual fees are current. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the licensee can request to be added to the distribution list to receive Quarterly Updates.

Exit interview conducted and report was reviewed with the licensee, Janet Holub. A Notice of Site Visit was given and must remain posted for 30 days. To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.



Effective today, LPA Guerra will recommend increase in capacity from a small family child care home to a large family child care home to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child is in at least Transitional kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years. When there is no assistant present, then it will revert back to the small capacity.

In the areas that were evaluated, no deficiencies were cited during inspection.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022
LIC809 (FAS) - (06/04)
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