343619361-7-18-2019-03-CC-CBEO-BE7RPH-20190718131159

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343619361
Report Date: 07/18/2019
Date Signed: 07/18/2019 01:12:07 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:	HANSEN, NANCY		FACILITY NUMBER:	343619361
ADMINISTRATOR:	HANSEN, NANCY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 682-6640
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95828
CAPACITY:	14	CENSUS: 8	DATE:	07/18/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Nancy Hansen		TIME COMPLETED:	01:30 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) Christopher Bello met with licensee Nancy Hansen for an unannounced random annual inspection and toured areas of the home accessible to children in care. Off-limit areas include son’s bedroom, exercise room, both side yards and garage. Licensee acknowledged that children may never enter these off-limit areas. The census included eight children. Also present was licensee’s son acting as an assistant. Licensee stated there are no new residents in the home since licensure. All Adult residents have criminal record clearances. LPA observed current CPR/First Aid certificates which expire on 6/2021. LPA discussed recent changes in licensing requirements, including the posting of licensing inspection notices and reports and Parent Notification Requirements. LPA reviewed some children’s files. LPA observed fire drills were conducted at least once every six months and documented. LPA notified licensee of upcoming safe sleep and lead testing regulations. LPA observed that there were no hazardous items accessible to children. LPA observed Fireplace which was screened. LPA observed that cleaning materials were inaccessible. Fire extinguisher, smoke detector and carbon monoxide detector meet regulation. Toys appear to be safe. The backyard is fenced and gated. Licensee stated there was a weapon in the home, LPA observed that the weapon was properly stored according to title 22 regulations, the weapon and ammunition were locked separately. *There are no bodies of water 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. REPORT CONTINUES ON NEXT PAGE.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher Bello	TELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019

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: HANSEN, NANCY	FACILITY NUMBER: 343619361
	VISIT DATE: 07/18/2019

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LPA observed current Mandated Reporter Training in file.
LPA checked facilities fees and confirmed that it is up to date.
LPA provided the Community Care Licensing’s 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 regards 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 director and provided copies. An exist interview was conducted. LPA observed the Notice of Site Visit posted and the director understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher Bello	TELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019

LIC809 (FAS) - (06/04)

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