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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619270
Report Date: 11/19/2019
Date Signed: 11/19/2019 01:18:08 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:DOYLE, MELINDAFACILITY NUMBER:
343619270
ADMINISTRATOR:DOYLE, MELINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 628-6156
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:14CENSUS: 6DATE:
11/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Melinda DoyleTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Jeevun Birk-Miller met with the licensee Melinda Doyle, for the purpose of an unannounced annual random inspection. All individuals subject to criminal background review have obtained a criminal record clearance. During the inspection the Licensee's asssistant and six children were present.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include: the entire upstairs, garage, and side yard. LPA observed the required postings, a working phone, 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors. LPA observed that the licensee had stairs barricaded. LPA observed a gun safe located in an off-limits area of the home. The storage of the items meet Title 22 regulation. Toxic and hazardous items are inaccessible to children. The fireplace in the home is appropriately barricaded to prevent access by children and outdoor play space is fenced. There is a spa on the premises and is inaccessible to children and care. The spa meets Title 22 regulations.

Six 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 05/2021 and AB 1207 Mandated Reporter Training was verified for both the licensee and the licensee's assistant. The Licensee's certificate expires 11/10/2021.

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.

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

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
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: DOYLE, MELINDA
FACILITY NUMBER: 343619270
VISIT DATE: 11/19/2019
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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. LPA provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochures. LPA and Licensee discussed the new Immunization Cards and the changes to the mandated reporter training.

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. No citations were issued during this inspection.

SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
LIC809 (FAS) - (06/04)
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