343618621-7-17-2023-03-CC-EBAN-CTTSC2-20230717134449

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343618621
Report Date: 07/17/2023
Date Signed: 07/17/2023 01:44:55 PM

Document Has Been Signed on 07/17/2023 01:44 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:	STILES, KIMBERLY		FACILITY NUMBER:	343618621
ADMINISTRATOR:	KIMBERLY STILES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 344-2446
CITY:	ANTELOPE	STATE: CA	ZIP CODE:	95843
CAPACITY:	14	CENSUS: 4	DATE:	07/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Kimberly Stilies, Licensee		TIME COMPLETED:	02:05 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 July 17, 2023, an unannounced annual/random inspection was made today by LPA Barragan. Present at time of inspection were licensee, 4 day care children. LPA Barragan spoke with Kimberly Stiles, Licensee. LPA tour of the home was conducted the inspection, inside and outside, as shown on the facility sketch is conducted. Licensee states there are no weapons or firearms in the home. There was no spas or pools in the home. LPA's observed poisons, cleaning compound's, medications and other hazardous items are inaccessible to children. There was a fireplace in the home, but it is inaccessible to the children. Fire extinguisher, Carbon Monoxide Detector and Smoke Detector meets regulations. Currently, Licensee has one dogs and the Licensee stated that the dog stays in the off limits area. The Licensee was reminded to ensure safety and appropriate supervision If the dogs are ever near the children. There are no stairs in the home. Toys and play equipment that were observed appeared to be safe. There is a working telephone. Adequate supervision is being provided during this inspection. Children are supervised when outside in any unfenced play area. There was 3 infant under 12 months old present. The home is a one story home with a front patio, 3 bedrooms, 2 bathrooms, kitchen, living room, dining room, small garage, laundry room, backyard, and little house in the backyard. The off-limit areas are the: small garage, little house in backyard, master bathroom, bedroom #1, and kitchen/dining room. Licensee was notified that prior to any changes of an on-limit to an off-limit area, or vice versa, the department must be notified. Pediatric CPR/FA is current with expiration date of 07/2025. A child roster is maintained. Fire and disaster drills have been conducted every six months and documented. (Last drill was completed 07/05/2023.) Four child's records were reviewed during this inspection.

SUPERVISOR'S NAME: Amanda Blesi	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Eduardo Barragan	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023

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: STILES, KIMBERLY	FACILITY NUMBER: 343618621
	VISIT DATE: 07/17/2023

NARRATIVE

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LPA's discussed AB 633, Parent Notification Requirements, and the posting of licensing inspection notices and reports. Hours of operation are 7 AM to 5 PM; Monday thru Friday and other hours as arranged. Licensee stated she does not transport children.

Licensee Kimberly Stilies, 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.

LPA discussed the safe sleep regulations with licensee Kimberly Stilies, Licensee, and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee Kimberly Stilies, 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.

LPA observed proof that licensee and staff/ volunteers have met the requirements of SB 792.

LPA observed that all staff has completed the required mandated reporter training. Mandated Reporter is current up until 04/2024. (AB 1207) at website: www.mandatedreporterca.com

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 .No children currently on medication.

SUPERVISOR'S NAME: Amanda Blesi	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Eduardo Barragan	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023

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: STILES, KIMBERLY	FACILITY NUMBER: 343618621
	VISIT DATE: 07/17/2023

NARRATIVE

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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 in regard to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

To receive important licensed- related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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/process.

No citations were administered during this inspection.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and a copy of this report and appeal rights were reviewed/provided with the Kimberly Stilies, Licensee.

SUPERVISOR'S NAME: Amanda Blesi	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Eduardo Barragan	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023

LIC809 (FAS) - (06/04)

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