343619223-6-7-2019-53-CC-ASIA-BCWQAM-20190607120011

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343619223
Report Date: 06/07/2019
Date Signed: 06/07/2019 12:00:16 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:	MCCLYMONDS, SUSAN		FACILITY NUMBER:	343619223
ADMINISTRATOR:	MCCLYMONDS, SUSAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 685-8963
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	14	CENSUS: 3	DATE:	06/07/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Susan McClymonds		TIME COMPLETED:	12:10 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) Amy Silva and Licensing Program Manager (LPM) Maria Mayorga met with Licensee, Susan McClymonds for an unannounced random annual inspection. The census included 3 children ages 6 months, 11 months, and 9 years. Licensee is registered with the Bean Stalk Food Program. LPA toured areas of the home accessible to children in care. Off-limit areas include: Entire upstairs, laundry room and Garage. Licensee acknowledges that children may never enter these off-limit areas. There are no "bodies of water" at this home. Licensee states there are no weapons or firearms in the home. LPA observed poisons, cleaning compound's, medications and other hazardous items are inaccessible to children. Fireplace contains a screen, and is inaccessible to children. Fire extinguisher, carbon monoxide detector and smoke detector meets regulations. There are no pets currently at the home. Stairs are barricaded when children under age 5 years old are present. Safe toys and play equipment are observed. 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. There are no excluded individuals present at this home. Pediatric CPR/FA is current with expiration date of 1/2020. Mandated reporter training is current and will expire 02/26/2020. A child roster is maintained. Fire and disaster drills are conducted every six months and documented. Children records were reviewed. Hours of operation are 7:30 AM to 5:30 PM; Monday thru Friday and other hours as arranged. Licensee states she does transport children. 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: MCCLYMONDS, SUSAN	FACILITY NUMBER: 343619223
	VISIT DATE: 06/07/2019

NARRATIVE

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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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