343620812-9-13-2023-03-CC-JVEO-CVMUJS-20230913153802

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343620812
Report Date: 09/13/2023
Date Signed: 09/13/2023 03:38:53 PM

Document Has Been Signed on 09/13/2023 03:38 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	BURNS, BREANNA		FACILITY NUMBER:	343620812
ADMINISTRATOR:	BURNS, BREANNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 293-2458
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	14	CENSUS: 8	DATE:	09/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Breanna Burns		TIME COMPLETED:	02:30 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 Jennifer Velasco (LPA) conducted an unannounced annual inspection and met with Licensee Breanna Burns (L1). LPA toured on-limits areas of the home. Facility hours of operation are Monday through Friday 7:00 AM to 5:30 PM. LPA observed that the annual facility fees are current. L1 stated she is no longer enrolling infants, who are children under two years of age. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. Off limit areas include: Fenced duck pond, garage, and two side yards. 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 ventilation. LPA observed the required documents were posted where visible to parents. LPA observed that there were no hazardous items—such as cleaning compounds, medications, or sharp objects—accessible to children. The fire extinguisher appeared to be in working condition and accessible. LPA observed the smoke and carbon monoxide detectors are functioning. The facility has equipment and toys safe for children. The backyard is fenced and L1 acknowledged that in areas that are not fenced, 100% supervision is required. LPA observed all weapons were inaccessible in a combination locked safe, and ammunition was locked separately. LPA observed the duck pond is fully fenced with a six foot fence and is compliant with regulatory requirements. 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 certificates were current. 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 Dunaway	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BURNS, BREANNA	FACILITY NUMBER: 343620812
	VISIT DATE: 09/13/2023

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Though L1 stated she is no longer enrolling infants, LPA discussed with L1 the safe sleep regulations and the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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 PIN 22-02-CCP. 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/resources/child-care-centers/.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. L1 was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit interview conducted and report was reviewed with L1. During the exit interview, L1 confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC809 (FAS) - (06/04)

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