343618339-2-27-2020-03-CC-KFEA-BM7QDW-20200227110526

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343618339
Report Date: 02/27/2020
Date Signed: 02/27/2020 11:05:32 AM

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:	JONES, MICHELLE		FACILITY NUMBER:	343618339
ADMINISTRATOR:	JONES, MICHELLE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 483-8774
CITY:	FOLSOM	STATE: CA	ZIP CODE:	95630
CAPACITY:	14	CENSUS: 10	DATE:	02/27/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Michelle Jones		TIME COMPLETED:	11:45 AM

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	Licensing Program Analyst (LPA) Kelly Ferrara met with Licensee Michelle Jones for an unannounced one year required inspection of her family child care home. All adults who live or work in the home have obtained a criminal record clearance. Hours of operation are Monday through Friday 7 AM-5:30 PM and the annual fees are current. There were ten children present at the time of inspection with the Licensee and an assistant. Licensee understands that when no assistant is present, she must revert back to a small license capacity. A health and safety inspection was conducted in all areas accessible to children. Off limit areas include: Third floor, all rooms and bathrooms on second floor, and garage. LPA observed a working phone, 2A10BC fire extinguisher, and a combined functioning smoke and carbon monoxide detector that meets regulations. LPA observed a first aid kit, current children's roster, and fire drill log with the last drill conducted in February 2020. LPA observed all the required Licensing documentation was posted including Parent's Rights, Emergency Disaster Plan, facility sketch, and the license. Knives, medications, and chemicals were all stored inaccessible to children. Licensee stated there are no firearms in the home. LPA observed the pool was fenced and gated according to regulations. LPA observed a file for the Licensee and her assistant which contained the required Licensing documents, proof of immunizations, and the Mandated Reporter certification. LPA advised that this training must be completed every two years. The website for the training is Mandatedreporterca.com. The Licensee and assistant both have a valid CPR/First Aid certificate which expires November 2021. LPA observed that all of the required documentation was present in each child's file. LPA advised that the public health form (CDPH286) for children's immunization record has changed and will be required for newly enrolled children.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

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: JONES, MICHELLE	FACILITY NUMBER: 343618339
	VISIT DATE: 02/27/2020

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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, available at: http://www.ada.gov/childqanda.htm.

Effects of Lead Exposure brochure was given to the Licensee. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. The facility evaluation report was reviewed and discussed and a copy of this report will remain on file for a period of 3 years for public review upon request. Notice of site visit was provided and it must remain posted for 30 days for parental review.

No citations were issued based on today's inspection.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

LIC809 (FAS) - (06/04)

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