343618339-3-18-2022-03-CC-KFEA-CCMT48-20220318142331

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343618339
Report Date: 03/18/2022
Date Signed: 03/18/2022 02:23:42 PM

Document Has Been Signed on 03/18/2022 02:23 PM - 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:	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: 6	DATE:	03/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Michelle Jones		TIME COMPLETED:	02:45 PM

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	On Friday, March 18th, 2022, Licensing Program Analysts (LPAs) Kelly Ferrara and Amanda Sutter conducted an unannounced annual inspection and met with Licensee Michelle Jones. LPAs observed there were currently six children in care with the Licensee. Facility hours of operation are Monday through Friday 7:30 AM to 5:30 PM. LPAs observed proper ratio and capacity was being followed. LPAs observed that the facility annual fees are current. 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. Off limit areas include: Third story, all rooms and bathrooms on second floor, and garage. Licensee acknowledged that children may never enter these off-limit areas. LPAs conducted a health and safety inspection and observed that the facility is clean, safe, sanitary, and in good repair with proper ventilation. LPAs observed the proper documents were posted where visible to parents. LPAs observed that the cleaning compounds, medications, and sharp objects were kept inaccessible to children. LPAs observed the fire extinguisher is in working condition and accessible. LPAs observed the smoke and carbon monoxide detectors are functioning properly. The facility has adequate toys that are safe for children to use. The backyard is fenced and LPAs observed the pool was fenced and gated according to regulations. LPAs observed the firearms were stored in a locked safe however the ammunition was also inside the safe. Licensee has a current Mandated Reporter training certificate and Licensee was reminded to complete the training every two years. LPAs observed fire drills were conducted at least once every six months and documented and the children’s roster is current. LPAs reviewed children’s files and observed that all the required documentation was present in each child's file.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022

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: 03/18/2022

NARRATIVE

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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.

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.

Incidental Medical Services- IMS policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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
LPA discussed current COVID guidelines with Licensee and provided technical assistance.

LPAs provided the Department’s website WWW.CCLD.CA.GOV, so the Licensee can obtain updated licensing information, new regulations and access forms. LPAs advised Licensee of their responsibility to stay current by reviewing PINs on the website. One Type A citation was issued based on today's inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with the licensee.

FOR TYPE A DEFICIENCIES ONLY upon receipt, Licensee shall post LIC 809 D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/18/2022 02:23 PM - It Cannot Be Edited

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102417(g)(4)(C)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (C) Ammunition shall be stored and locked separately from firearms. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPAs observation the licensee did not comply with the section cited above and LPAs observed the firearms were locked in a safe with ammunition which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/21/2022
	Plan of Correction
1 2 3 4	Licensee purchased a second safe with LPAs present and stated she will lock the ammunition inside of it which will be separate from the firearms. Licensee shall submit pictures to LPA Ferrara by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022

LIC809 (FAS) - (06/04)

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