343619036-6-7-2019-53-CC-ASIA-BCWSXR-20190607141623

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343619036
Report Date: 06/07/2019
Date Signed: 06/07/2019 02:16:28 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:	BLOOMGREN, RACHEL		FACILITY NUMBER:	343619036
ADMINISTRATOR:	BLOOMGREN, RACHEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 521-0082
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	14	CENSUS: 12	DATE:	06/07/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Rachel Bloomgren		TIME COMPLETED:	02:30 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) Amy Silva and Licensing Program Manager Maria Mayorga met with licensee Rachel Bloomgren for an unannounced random annual inspection. The census included 12 children ages 6 months, 1, 3, 3, 3, 3, 3, 3, 4, 5, 6 and 8. Also present on today's date was Rachel's assistant, Chloe Dart. Licensee is registered with the Bean Stalk Food Program. LPA toured areas of the home accessible to children in care. Off-limit areas include: Main house, Garage, and Duck Pond Area. Licensee acknowledges that children may never enter these off-limit areas. The backyard is fenced and gated. LPA observed a swing set/ Jungle Gym which is cemented into ground and a tool shed/barn in backyard which is located behind a fence, making it inaccessible to children. Fireplace was observed and contains a screen and is inaccessible to children. LPA observed current CPR/First Aid certificates which expire on 4/5/2021. LPA observed Mandated Reporter training is current and will expire 1/4/2020. LPA reviewed children’s files. A child roster is maintained. LPA observed fire drills were conducted at least once every six months and documented. Facilities hours of operation are 7:00 AM to 5:00 PM; Monday thru Friday and other hours as arranged. Licensee states she does not transport children. All Adult residents have criminal record clearances and are associated to the facility. LPA observed that there were no hazardous items accessible to children. LPA observed that cleaning materials were inaccessible to children. Licensee stated there are no weapons in the home. Fire extinguisher 2A10BC, smoke detector and carbon monoxide detector meet regulation. Currently, licensee does have several pets (dogs, horses, chickens, cats, peacocks, etc.) that are inaccessible to children. Toys appear to be safe and age appropriate. There is a working telephone. Adequate supervision is being provided during this visit. The capacity as specified on the license is being maintained. Staff-child ratios are maintained. All adults who reside or work in the home have a criminal record clearance or exemption. Report continued on page 2

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019

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: BLOOMGREN, RACHEL	FACILITY NUMBER: 343619036
	VISIT DATE: 06/07/2019

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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.

LPA reviewed with licensee the handouts “A Child Care Provider’s Guide to Safe Sleep” and “Safe Sleep Regulation Concepts” and "Lead Poisoning Facts" and gave her a copy of these handouts.

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.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the Licensee and provided copies. An exit interview was conducted. Appeal rights provided. Notice of Site Visit was provided and Licensee understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019

LIC809 (FAS) - (06/04)

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