343618994-12-13-2019-03-CC-JKEY-BJU2ZQ-20191213165044

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343618994
Report Date: 12/13/2019
Date Signed: 12/13/2019 04:51:05 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:	UNDERHILL, OFELIA		FACILITY NUMBER:	343618994
ADMINISTRATOR:	UNDERHILL, OFELIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 419-2191
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95835
CAPACITY:	14	CENSUS: 10	DATE:	12/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Ofelia Underhill, Licensee		TIME COMPLETED:	05:10 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	Licensing Program Analyst (LPA) Joleen Kenney met with the Licensee, Ofelia Underhill, for the purpose of an unannounced annual/random inspection. All individuals subject to criminal background review have obtained a criminal record clearance. Hours of operation for the facility are Monday-Friday, 7:30 AM to 5:30 PM. During today's inspection LPA observed 10 children supervised by the Licensee. There were no other Assistants present in the home upon LPAs arrival to the home and there was one school age child present in the home. The Licensee stated that her spouse was picking up school age children and would be returning to the home. The Licensee's spouse returned to the home with 3 school age children during the inspection. A health and safety inspection was conducted in all areas accessible to children. Off-limits areas includes the entire upstairs, laundry room and garage. Licensee acknowledged that children must never enter these areas. LPA observed the required postings, a working phone, fire extinguisher, and smoke and carbon monoxide detectors. Licensee stated there are no weapons in the home. The fenced backyard is accessible for children to play. Licensee understands children must have 100% supervision in unfenced areas. Toxic and hazardous items are inaccessible to children. The fireplace is appropriately barricaded to prevent access by children. Children’s files were reviewed. LPA observed immunization records and signed Family Child Care Home Notification of Parents' Rights in children's files. LPA observed a current children's roster. Fire and disaster drills are being conducted and documented. The licensee's immunization records for measles (MMR), pertussis (Tdap), and the flu were verified. Licensee has a in person EMSA CPR and First Aid certification that expires 4/27/2021. Licensee has completed the Mandated Reporter Training that expires in March 2020. Licensee understand that the training is required to be completed once every two years and the training is accessible at www.mandatedreporterca.com. Report continues on 809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen Kenney	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2019

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: UNDERHILL, OFELIA	FACILITY NUMBER: 343618994
	VISIT DATE: 12/13/2019

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This Licensee does not currently provide 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: https://www.ada.gov/childqanda.htm.

LPA verified that the annual fees are current. LPA provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochures.

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. The licensee's signature on this form acknowledges receipt of this form.

The following Type A deficiency was cited on the subsequent page. Upon receipt, licensee shall post 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. The LIC 9224 must be signed by parents/guardians and kept as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 is available on the website. If the LIC 9224 is not used, the licensee shall prepare a statement indicating the documents have been provided. Licensee shall require the parent/guardian to sign and date the statement and shall keep the signed statement as receipt. Verification of receipt shall be kept in each child's file at the facility.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen Kenney	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: UNDERHILL, OFELIA	FACILITY NUMBER: 343618994
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/13/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/16/2019 Section Cited	1 2 3 4 5 6 7	If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). The total licensed capacity for a Small Family Child Care Home shall not exceed eight children.
	8 9 10 11 12 13 14	This requirement is not met as evidence by: LPA observed 10 children present with only the Licensee and one of the children was a school age child. The Licensee's spouse was picking up school age children from the school at the time of LPAs arrival to the home. This poses an immediate health and safety risk to children in care.	8 9 10 11 12 13 14	LPA will conduct a future unannounced inspection to verify that the Licensee is in compliance with the staffing ratio and capacity.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen Kenney	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2019

LIC809 (FAS) - (06/04)

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