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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618325
Report Date: 01/23/2020
Date Signed: 01/23/2020 01:28:47 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:WADE, JACKIEFACILITY NUMBER:
343618325
ADMINISTRATOR:WADE, JACKIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 335-1507
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:14CENSUS: DATE:
01/23/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jackie WadeTIME COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lea Habtom and Amanda Blesi met with licensee Jackie Wade for an unannounced annual/random inspection. Present at the time of inspection was licensee and 7 preschool and school age children.

A tour of the home, inside and outside, as shown on the facility sketch was conducted. Observed tool shed in backyard behind a fence. There is a trampoline in the backyard. Off-limit rooms are: Master bedroom/bathroom, second bedroom and garage. Licensee acknowledges that children may never enter these off-limit areas.

Licensee states there are no weapons or firearms in the home. There is a small pond, seven feet by four feet, that is gated by a wrought iron fence that meets regulation. LPA observed hazardous items (detergents, cleaning compounds, medication, sharp utensils, and other items that could pose a danger to children in care) are properly stored out of children's reach. Fireplace contains a screen and is inaccessible to children. There is a working telephone. Fire extinguisher, carbon monoxide detector and smoke detector meet regulations. Toys and play equipment that were observed appear to be safe.

Adequate supervision is being provided during this inspection. The capacity as specified on the license is 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 3/2020. A child roster is maintained. Fire and disaster drills are conducted every six months and documented. Children records reviewed. (End of page 1)
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020
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: WADE, JACKIE
FACILITY NUMBER: 343618325
VISIT DATE: 01/23/2020
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LPA observed proof that licensee and staff/ volunteers have met the requirements of SB 792.

LPA observed that all staff 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 and gave licensee 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.

Hours of operation are 7:30 AM to 5:30 PM; Monday to Friday and other hours as arranged.

Licensee states she does 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 regarding new regulations. LPA also included the email address for the child care advocates program so licensee can request to be added to the distribution list to receive Quarterly Updates. childcareadvocatesprogram@dss.ca.gov.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, NO deficiencies were observed today. This report was reviewed and discussed
with licensee at time of inspection.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020
LIC809 (FAS) - (06/04)
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