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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343620080
Report Date: 10/12/2022
Date Signed: 10/12/2022 10:10:40 AM


Document Has Been Signed on 10/12/2022 10:10 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:PETTERBORG, SHARONFACILITY NUMBER:
343620080
ADMINISTRATOR:PETTERBORG, SHARONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 988-2816
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:14CENSUS: 11DATE:
10/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Sharon PetterborgTIME COMPLETED:
10:15 AM
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Licensing Program Analyst Jennifer Velasco (LPA) conducted an unannounced annual inspection and met with Licensee Sharon Pettersborg (L1). LPA observed 11 children in care with the Licensee and an assistant. Facility hours of operation are Monday through Friday 8:30 -11:30 AM, Tuesday-Thursday, during the school year. LPA observed that the annual facility fees are current.

L1 was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Off limit areas include: Upstairs, garage, kitchen/dining/living room, two downstairs bedrooms, bathroom, north side yard. L1 acknowledged that children may never enter these off-limit areas. LPA conducted a health and safety inspection and observed that the facility is clean, safe, sanitary, and in good repair with proper ventilation. LPA observed required documents were posted where visible to parents. LPA observed that the cleaning compounds, medications, and sharp objects were kept inaccessible to children. LPA observed a 2A-10-BC fire extinguisher which is accessible. LPA observed the smoke and carbon monoxide detectors are functioning properly. The facility has toys and equipment safe for children to use. The backyard is fenced. LPA observed there were no bodies of water. L1 stated there are no firearms in the home.

LPA observed a current children's roster and fire drill log. LPA reviewed children’s files and observed that all the required documentation was present in each child's file. LPA observed the CPR/First Aid certificate was current and expires February 2023. LPA observed a current Mandated Reporter certificate for L1 and assistant(s). L1 was reminded the Child Care portion must be completed every two years. LPA reviewed staff and facility files and observed the required documentation.
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2022
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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: PETTERBORG, SHARON
FACILITY NUMBER: 343620080
VISIT DATE: 10/12/2022
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Though she does not enroll infants, LPA discussed with L1 the safe sleep regulations and the Child Care Licensing Safe Sleep web page athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed L1 of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services- IMS policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 discussed current COVID guidelines with Licensee and provided technical assistance.

LPA discussed current COVID guidelines with Licensee and provided technical assistance. LPA provided the Department’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 by reviewing PINs on the website.

There were no citations issued during today's inspection. A notice of site visit was given to L1 and must remain posted for 30 days. Exit interview was conducted and report was reviewed with L1.
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
LIC809 (FAS) - (06/04)
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