343619193-6-27-2019-03-CC-MLOR-BDJNCF-20190627102039

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343619193
Report Date: 06/27/2019
Date Signed: 06/27/2019 10:20:57 AM

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:	MARTIN, JILLIAN		FACILITY NUMBER:	343619193
ADMINISTRATOR:	MARTIN, JILLIAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 670-1136
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95829
CAPACITY:	14	CENSUS: 5	DATE:	06/27/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Jillian Martin		TIME COMPLETED:	10:30 AM

NARRATIVE

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Licensing Program Analyst (LPA) Mai Lor and Licensing Program Manager (LPM) Roxana Saravia conducted an unannounced annual random inspection on 6/27/19. During this inspection, LPA and LPM met with Licensee Jillian Martin. The census included 5 children, one under the age of two. All adults residing in the home have criminal record clearances. Hours of operation are Monday through Friday from 7:00 a.m. to 5:30p.m. Appropriate ratio, care and supervision were observed during the visit. Licensee was reminded never to exceed the conditions, limitations and capacity specified on the license.

A health and safety inspection was conducted in all areas accessible to children. Licensee requested the backyard with the pool to be off limit. LPA conducted an inspection and the the backyard with the pool is off limit. Off-limit areas include: upper level, laundry room, backyard with the pool, and garage. Licensee understands that children may never enter these off-limit areas. Applicant acknowledges she is required to notify licensing prior to making changes to off-limit areas so that they may be inspected for safety. The home is kept clean and orderly with heating and ventilation for safety and comfort. The pool in the backyard is fenced and meets Title 22 Regulations. Licensee stated there are no weapons on premises. The fireplace is appropriately barricaded to prevent access by children. Fire extinguisher is fully charged. Smoke detectors and carbon monoxide detector are operable. Safety latches are in use on some kitchen cabinets and bathroom cabinets and drawers. The applicant understands that she must ensure the safety latches are not broken. The home provides safe toys, play equipment and materials. The home has a working telephone. The backyard is fenced, and LPA advised applicant that in areas that are not fenced, supervision must always be maintained. Medications, toxic and hazardous items are appropriately stored and inaccessible to children.

(Report continue on subsequent LIC 809)

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019

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: MARTIN, JILLIAN	FACILITY NUMBER: 343619193
	VISIT DATE: 06/27/2019

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Five children, Licensee and her assistant's records were reviewed. All records contained the required documentation. Licensee has a current CPR/First Aid certificate which expires 6/2020. Licensee completed mandated reporter training. Licensee was advised that this training is required every two years. A fire drill log was observed with the last fire drill conducted on 9/2018. All required licensing postings was observed.

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 verified the annual fees are current. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the licensee can request to be added to the distribution list to receive Quarterly Updates. LPA provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochures.

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.

Facility cited for Title 22 Regulations Division 1, Operation of Family Child Care HomeSection 102417(g)(A) . Record reviewed showed the last fire drill was conducted on 9/2018. Appeal rights discussed and provided to the Licensee. LPA reviewed report with the Licensee and provided copies. An exit interview was conducted, and a Notice of Site was provided. Licensee understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019

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: MARTIN, JILLIAN	FACILITY NUMBER: 343619193
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/27/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/26/2019 Section Cited CCR 102417(g)(A)	1 2 3 4 5 6 7	Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee shall conduct a fire drill and send proof of fire drill to LPA by 7/26/19 via email or fax.
	8 9 10 11 12 13 14	Based on record review, the last fire drill was conducted on 9/2018, which poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	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: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019

LIC809 (FAS) - (06/04)

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