343620377-6-14-2021-53-CC-ASIA-C3YUA6-20210614152414

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343620377
Report Date: 06/14/2021
Date Signed: 06/14/2021 03:24:18 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:	MILLIKEN, TRACY		FACILITY NUMBER:	343620377
ADMINISTRATOR:	MILLIKEN, TRACY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 806-9312
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	14	CENSUS: 5	DATE:	06/14/2021
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Tracy Milliken		TIME COMPLETED:	03:15 PM

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Licensing Program Analyst (LPA) Amy Silva met with Licensee, Tracy Milliken for an unannounced annual inspection. LPA observed five children in care. Licensee is registered with Framax Food Program.

A tour of the home, inside and outside, as shown on the facility sketch was conducted. Swimming pool is fenced per regulation. 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. Off-limit rooms include: Entire main house. Master bedroom, Music room and back yard where pool is located. Licensee acknowledges that children may never enter these off-limit areas. Swing set observed and is anchored into ground. LPA observed tool shed in backyard and that locked by key lock. Carbon monoxide detector and smoke detector were tested at 2:00 PM and were operable and meets regulations. Safe toys and play equipment are observed. A 2A10BC Fire extinguisher was observed in the kitchen. 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/First Aid is current. Mandated reporter training is current. A child roster is maintained. Fire and disaster drills are conducted once a month and documented. Three of five child records were reviewed and two of three staff files were reviewed. LPA observed current CPR/First Aid certificate for Licensee which expires in June 2023 and a current Mandated Reporter training certificate which expires in June of 2023. Hours of operation are 7:00 AM to 5:30 PM; Monday thru Friday and other hours as arranged.

LPA reviewed with licensee the handouts “A Child Care Provider’s Guide to Safe Sleep” and “Safe Sleep Regulation Concepts” and "Lead Poisoning Facts."

Report continues on 809C

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

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: MILLIKEN, TRACY	FACILITY NUMBER: 343620377
	VISIT DATE: 06/14/2021

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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 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: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

LIC809 (FAS) - (06/04)

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