343620599-8-29-2019-03-CC-JKEY-BFHV7Y-20190829161156

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343620599
Report Date: 08/29/2019
Date Signed: 08/29/2019 04:12:06 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:	DOLAR, PRISCILLA		FACILITY NUMBER:	343620599
ADMINISTRATOR:	DOLAR, PRISCILLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 515-2030
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95835
CAPACITY:	14	CENSUS: 5	DATE:	08/29/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Priscilla Dolar, Licensee		TIME COMPLETED:	04:30 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 Analysts (LPAs) Joleen Kenney and Fabiola Diaz met with the licensee, Priscilla Dolar, for the purpose of an unannounced annual random inspection. All individuals subject to criminal background review have obtained a criminal record clearance. Hours of operation for the facility is 8:30AM-6:00PM, Monday thru Friday. Census at the time of arrival was 5 children. A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include the upstairs and garage. Licensee acknowledged that children must never enter these areas. LPA observed the required postings, a working phone, fire extinguisher, and smoke and carbon monoxide detectors. Licensee stated there are no weapons in the home. There are no bodies of water on the premises. Toxic and hazardous items were discussed with the Licensee and are inaccessible to children. The stairs in the home are barricaded with a baby gate, the fireplace is appropriately barricaded to prevent access by children, and backyard outdoor play space is fenced. Licensee understands that 100% supervision is required in unfenced areas. Children’s files were reviewed. LPA observed immunization records and signed Family Child Care Home Notification of Parents' Rights in children's files. Licensee is maintaining a current children's roster. Fire and disaster drills were documented. The licensee's immunization records for measles (MMR), pertussis (Tdap), and the flu were verified. Licensee has a current in person EMSA CPR and First Aid certification that expires on 7/22/2021. Licensee will complete the AB 1207 Mandated Reporter Training. Licensee understand that the training is required to be completed once every two years and the training is accessible at www.mandatedreporterca.com. Report continues on 809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen Kenney	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019

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: DOLAR, PRISCILLA	FACILITY NUMBER: 343620599
	VISIT DATE: 08/29/2019

NARRATIVE

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This provider is currently 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.

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: https://www.ada.gov/childqanda.htm.

LPA verified that the annual fees are current. LPA will register the Licensee to be added to the distribution list to receive Quarterly Updates. LPA provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochures.

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.ccld.ca.gov for child care updates, current forms, legislation and regulation information. The licensee's signature on this form acknowledges receipt of this form.

In the areas that were evaluated, no deficiencies observed or cited during todays visit.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen Kenney	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019

LIC809 (FAS) - (06/04)

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