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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343620572
Report Date: 07/16/2019
Date Signed: 07/16/2019 10:22:14 AM

COMPREHENSIVE INSPECTION
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:WORDEN, EDITHFACILITY NUMBER:
343620572
ADMINISTRATOR:WORDEN, EDITHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 471-9269
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:14CENSUS: 7DATE:
07/16/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Edith WordenTIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Kelly Ferrara and Mai Lor met with Licensee Edith Worden for an unannounced random annual inspection of her large family child care home. All adults who live and work in the home have obtained a criminal record clearance. Hours of operation are Monday through Friday 8 AM- 5 PM . There were seven children present at the time of inspection.
A health and safety inspection was conducted in all areas accessible to children. Off limit areas include: entire upstairs, laundry room, garage, and side yard. LPAs observed a working phone, 2A10BC fire extinguisher, fireplace that is screened, first aid kit, and functioning smoke and carbon monoxide detectors that meet regulations. LPAs observed a current children's roster and a fire drill log with the last drill conducted in February 2019. Knives, medications, and chemicals were all stored inaccessible to children. LPAs did not observe any bodies of water on the premises and Licensee stated there were no firearms in the home.
LPAs observed documentation for the Licensee and her assistants. LPAs observed that Mandated Reporter training had been completed and LPA advised that this must be done every two years. LPAs observed a current CPR/First Aid certificate that expires June 23rd, 2020. Licensee provided proof of her immunizations for herself and her assistant. All children's files were reviewed and LPAs observed that all of the required documentation was present.
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.
The facility evaluation report was reviewed and discussed with the Licensee. Licensee was encouraged to visit the Department website at WWW.CCLD.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 3 years for public review upon request. Notice of site visit was provided and it must remain posted for 30 days for parental review. No citations were issued based on today's inspection.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5935
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
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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