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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618928
Report Date: 02/26/2020
Date Signed: 02/26/2020 01:45:22 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:ACOSTA, MICHELLEFACILITY NUMBER:
343618928
ADMINISTRATOR:ACOSTA, MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 419-3263
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:14CENSUS: 1DATE:
02/26/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Michelle AcostaTIME COMPLETED:
02:00 PM
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On Wednesday February 26, 2020, Licensing Program Analyst (LPA) Jeremey McClain met with Licensee Michelle Acosta for an unannounced annual inspection.

Upon arrival, one child was present that was preschool age. Licensee stated there aren’t new residents in the home. All adults present today have criminal record clearances.

LPA toured areas of the home accessible to the children. The off-limit areas of the home are all areas except for the downstairs bedroom and bathroom, and the back yard.

LPA observed current CPR/First Aid certificate which expires 03/03/2021. LPA observed the following posted: a license, a Parents' Rights Poster and an Emergency Disaster Plan.

LPA reviewed children’s records for completeness, as well as the client roster. Licensee provided proof of immunizations for MMR, Pertussis, and influenza.

LPA discussed the Provider Information notice 19-08-CCP which discusses new immunization requirements from the Department of Public Health. LPA provided licensee with and updated CPDH 286 for recording children’s immunizations.

During the interior and exterior inspection:
LPA observed that hazardous items (detergents, cleaning compounds, medication, sharp utensils, and other items that could pose a danger to children in care) are properly stored out of children's reach.
LPA observed a fireplace that was properly screened, and stairs were properly barricaded.
LPA observed a working telephone in the home.
Licensee stated that there are no weapons in the home.
LPA observed a fire extinguisher which was last serviced on August 2018. Licensee stated the Fire Extinguisher was serviced last year in 2019, but the inspector did not indicate it on the tag. Carbon monoxide and smoke detectors were tested and observed to be functional.
LPA observed fire drills documented on a calendar, indicating that the licensee is conducting disaster drills at least once every 6 months.
Equipment and furnishings in areas where children are active appeared to be safe and in working order.
LPA did not observe any accessible bodies during today’s inspection.
REPORT CONTINUED ON THE FOLLOWING PAGE.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: ACOSTA, MICHELLE
FACILITY NUMBER: 343618928
VISIT DATE: 02/26/2020
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Incidental Medical Services (IMS) was discussed and the licensee is not currently providing IMS. LPA discussed safety precautions and best practices for when these services are provided to children in care.

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 provided Licensee with website: http://childcare.mandatedreporterca.com/ and reminded the licensee that the training must be completed once every two years.



LPA discussed recent changes in licensing requirements, Safe Sleep Regulations Concepts and provided licensee with Provider Information Notice. LPA also provided licensee with CDSS’ AB 2370 brochure regarding the effects of lead exposure. LPA provided the licensee with the Winter 2020 quarterly update from the Childcare Advocates program.

No deficiencies were observed during today’s inspection.



This report was reviewed with licensee, and an exit interview was conducted.

A Notice of Site Visit was provided and should remain posted for 30 days.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
LIC809 (FAS) - (06/04)
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