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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619036
Report Date: 05/03/2023
Date Signed: 05/03/2023 12:39:34 PM


Document Has Been Signed on 05/03/2023 12:39 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:BLOOMGREN, RACHELFACILITY NUMBER:
343619036
ADMINISTRATOR:BLOOMGREN, RACHELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 521-0082
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:14CENSUS: 11DATE:
05/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Rachel Bloomgren TIME COMPLETED:
12:45 PM
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On May 3, 2023, Licensing Program Analysts (LPA) Stacey Williams and Jennie Tedlos conducted an unannounced 1 Year required inspection and met with Licensee, Rachel Bloomgren . There were eleven children in the home being supervised by Licensee and her two Assistants. Criminal record clearances have been verified. Facility fees were reviewed and are current. Licensee stated there are no new residents in the home since licensure. Licensee’s operation hours are Monday- Thursday, 8:30AM- 3:15PM and Friday: 8:30 AM- 12:00 PM. Licensee stated she does not provide overnight care.

LPAs and Licensee toured the facility during the inspection. Off limit areas are the main house including the master bedroom and bathroom, the garage, and fenced pool and pond area. The outdoor play space is fenced, and the duck pond on the premises is inaccessible to children in care. LPAs observed an in-ground pool that meets Title 22 Regulations and is not used by children in care. LPAs also observed several pets (dogs, cats, chickens, rabbits, sheep, goats and a pony, etc.), Licensee stated that all children are supervised when interacting with the animals in their pens.

LPAs conducted record reviews during the inspection. Ten children’s files were reviewed and determined to be in compliance with licensing requirements. Licensee and her Assistant’s file was reviewed. LPAs discussed mandated reporter training with the Licensee. Mandated Reporter Training is current. Licensee understands Mandated Reporter Training is to be completed every two years. Mandated reporter training can be accessed www.mandatedreporterca.com. CPR/First Aid certification was reviewed. Expiration date is 4/2025. LPAs observed fire drills were conducted at least once every six months and documented.

LPAs observed that there were no hazardous items accessible to children. LPAs observed that cleaning materials were inaccessible. Fire extinguisher, smoke detector, and carbon monoxide detector meet regulation. Toys appear to be safe.

REPORT CONTINUED ON SUBSEQUENT PAGE, LIC 809 C
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: BLOOMGREN, RACHEL
FACILITY NUMBER: 343619036
VISIT DATE: 05/03/2023
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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 of the 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.

This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. The following information regarding ADA Information 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

LPAs discussed the requirement to check and log infants napping every 15 minutes for infants up to 24 months and under. LPA discussed the safe sleep regulations with 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 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.

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 Title 22 deficiencies were observed in the areas that were evaluated.

LPAs reviewed report with the Licensee, Rachel Bloomgren and provided copies of the report along with Appeal Rights. A notice of site visit was provided and posted by LPA Williams and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC809 (FAS) - (06/04)
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