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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618688
Report Date: 01/24/2020
Date Signed: 01/24/2020 01:26:54 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:HUBBARD, LATICEFACILITY NUMBER:
343618688
ADMINISTRATOR:HUBBARD, LATICEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 684-0334
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:14CENSUS: DATE:
01/24/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Latice HubbardTIME COMPLETED:
12:32 PM
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Licensing Program Analyst (LPA) Jeevun Birk-Miller met with the licensee, Latice Hubbard, for the purpose of an unannounced annual inspection. All individuals subject to criminal background review have obtained a criminal record clearance. A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include: garage and laundry room.

LPA observed the required postings, a working phone, 3A40BC fire extinguisher, and functioning smoke and carbon monoxide detectors. Toxic and hazardous items are inaccessible to children. There are no bodies of water on the premises. The Licensee stated there are no firearms at the facility.

Three children’s files were reviewed. Emergency information and required immunization records were on file. The licensee's immunization records for measles (MMR), pertussis (Tdap), and the flu are available in the facility file. Current in person EMSA CPR and First Aid certification was verified and expires 08/14/2020 and AB 1207 Mandated Reporter Training was verified for the licensee. The Licensee's certificate expires 03/27/2020. LPA discussed the changes to the mandated reporter training.

This provider is currently not providing IMS services to children in care. 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.

Continued on to 809-C page...
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
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: HUBBARD, LATICE
FACILITY NUMBER: 343618688
VISIT DATE: 01/24/2020
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LPA provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochures. LPA and Licensee discussed the new Immunization Cards. This facility evaluation report was reviewed and discussed with the licensee.

A Notice of Site Visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.

No citations were issued during this inspection.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
LIC809 (FAS) - (06/04)
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