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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619237
Report Date: 02/07/2020
Date Signed: 02/07/2020 09:30:08 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:BURKE, JULIEFACILITY NUMBER:
343619237
ADMINISTRATOR:BURKE, JULIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 744-1319
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY:14CENSUS: 2DATE:
02/07/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:11 AM
MET WITH:Julie BurkeTIME COMPLETED:
09:32 AM
NARRATIVE
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Licensing Program Analyst (LPA) Jeevun Birk-Miller met with the licensee, Julie Burke, for the purpose of an unannounced annual inspection. The Licensee's assistant and two children were at the facility during the inspection. All individuals subject to criminal background review have obtained a criminal record clearance. A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include: laundry room and master bedroom.

LPA observed the required postings, a working phone, 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors. Toxic and hazardous items are inaccessible to children. There are no bodies of water on the premises. The Licensee stated there are no firearms at the facility.

Two children’s files were reviewed. Emergency information and required immunization records were on file. The licensee's immunization records for measles (MMR), pertussis (Tdap), and the flu are available in the facility file. Current in person EMSA CPR and First Aid certification was verified and expires 07/2021 for the assistant. At 8:47 AM the LPA did review of the Licensee and staff files and observed that AB 1207 Mandated Reporter Training was not completed for the licensee and her assistant. LPA discussed the changes to the mandated reporter training. mandatedreporterca.com

This provider is currently not providing 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: http://www.ada.gov/childqanda.htm.

Continued on to 809-C page...
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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: BURKE, JULIE
FACILITY NUMBER: 343619237
VISIT DATE: 02/07/2020
NARRATIVE
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LPA verified the annual fees are not current and it was discussed with the Licensee what is owed. Licensee stated she would make sure to get that paid. During the inspection the Licensee paid her fees online and showed proof. LPA provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochures. LPA and Licensee discussed the new Immunization Cards. 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. 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. The following Type-B citation was cited on the 809-D page of this report.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020
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: BURKE, JULIE
FACILITY NUMBER: 343619237
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2020
Section Cited

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On or before March 30, 2018, a person who, on January 1, 2018, a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years
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following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by: Based on record review the licensee and her assistant did not complete the mandated reporter training. This poses a potential health and safety risk to children in care.
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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: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3