343618616-2-15-2024-03-CC-MGAO-D2GU7X-20240215142039

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343618616
Report Date: 02/15/2024
Date Signed: 02/15/2024 02:20:46 PM

Document Has Been Signed on 02/15/2024 02:20 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	SMITH, JENNIFER ANN		FACILITY NUMBER:	343618616
ADMINISTRATOR:	SMITH, JENNIFER ANN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 332-2563
CITY:	ANTELOPE	STATE: CA	ZIP CODE:	95843
CAPACITY:	14	CENSUS: 12	DATE:	02/15/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Jennifer Ann Smith		TIME COMPLETED:	02:30 PM

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At 1:05pm on 12/15/2024, Licensing Program Analysts (LPA) Matthew Gallo and Fabian Schwartz met with licensee Jennifer Ann Smith for the purpose of an unannounced required 1-year inspection. Licensee states no others are present in the home today except for their husband, mother, and adult assistant, who were present for the inspection. Today's census included 12 children consisting of 9 preschool children and 3 infants.

Licensee guided LPAs on a tour of the facility, and a health and safety inspection was conducted in all areas accessible to children. Off-limits areas include all second story, sheds, and detached garage. Licensee acknowledged that children must never enter these areas. LPA observed the required postings, a working phone, 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors. Per Licensee, there are no weapons in the home. LPAs observed a hot tub with a hard-shell cover properly locked according to regulation. Toxic and hazardous items are inaccessible to children. Stairs are properly fenced to prevent access by children. There is a faux fireplace in the living room that does not require a barricade. Outdoor play space is fenced.

Criminal record clearances were verified, and licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPAs reviewed 12 children’s files and observed them to be complete. A current roster is being maintained and fire and disaster drills are documented. Current CPR and First Aid certification was verified and expires 1/2025, and AB 1207 Mandated Reporter Training was verified for the Licensee and expires 2/2026.

Report continues LIC809-C

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Matthew Gallo	TELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SMITH, JENNIFER ANN	FACILITY NUMBER: 343618616
	VISIT DATE: 02/15/2024

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Licensee stated she places infant children on their backs when they are napping. LPA discussed infant sleep plan (LIC 9227) requirement with Licensee, and 15-minute observation checks of napping infants.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

No deficiencies were cited during today’s inspection.

Exit interview conducted and report was reviewed with the licensee, Jennifer Ann Smith. A notice of site visit was given and must remain posted for 30 days. Appeal rights provided.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Matthew Gallo	TELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

LIC809 (FAS) - (06/04)

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