343621637-1-27-2020-03-CC-JKEY-BL8R9L-20200127114943

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343621637
Report Date: 01/27/2020
Date Signed: 01/27/2020 11:49:53 AM

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:	PIERCE, TIFFANY		FACILITY NUMBER:	343621637
ADMINISTRATOR:	PIERCE, TIFFANY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 743-0397
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95833
CAPACITY:	14	CENSUS: 6	DATE:	01/27/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Tiffany Pierce, Licensee		TIME COMPLETED:	12:05 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 (LPA) Joleen Kenney met with the Licensee, Tiffany Pierce, 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 are Monday-Sunday for 24 hours. During today's inspection LPA observed 6 children supervised by the Licensee and one Assistant. A health and safety inspection was conducted in all areas accessible to children. The Licensee has requested that the computer room be changed from off limits to on limits to allow the area to be used for napping children. LPA Kenney inspected the computer room and determined that the space was safe for children in care and has updated the area as on limits on the license. Off-limits areas includes bedroom #2, master bedroom 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. The day-care children have access to the fenced backyard for outside play. Licensee understands children must have 100% supervision in unfenced areas. Toxic and hazardous items are inaccessible to children. The fireplace is appropriately barricaded to prevent access by children. Children’s files were reviewed. LPA observed immunization records and signed Family Child Care Home Notification of Parents' Rights in children's files. LPA observed a current children's roster. Fire and disaster drills are being conducted and documented. The licensee's and Assistant's immunization records for measles (MMR), pertussis (Tdap), and the flu were verified. Licensee has a in person EMSA CPR and First Aid certification that expires on 1/19/2021. Licensee has completed the Mandated Reporter Training and is currently in the process of completing the training to renew her certification. 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: 01/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2020

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: PIERCE, TIFFANY	FACILITY NUMBER: 343621637
	VISIT DATE: 01/27/2020

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This Licensee does not currently provide 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 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.CDSS.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 were 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: 01/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2020

LIC809 (FAS) - (06/04)

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