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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621972
Report Date: 08/13/2019
Date Signed: 08/13/2019 12:41:19 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:LAWS, MARYFACILITY NUMBER:
343621972
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
08/13/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:Mary LawsTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Jeevun Birk-Miller conducted an unannounced case management visit and met with Mary Laws. During the visit the licensee's two children were present. The purpose of today's visit was for an increase in capacity. Licensee has requested a capacity increase to 14 children. A fire clearance has been approved by the local Consumes Community Services District fire marshal. LPA Birk-Miller observed a working 2-A-10-BC fire extinguisher and a working smoke and carbon monoxide detector. LPA observed the newly installed fire pull system. Licensee stated there are no new residents in the home since being licensed and all adults who require fingerprint clearances have received the required clearance. LPA and Mary discussed staff records and items needed for when an assistant is hired. LPA checked the fingerprint clearance status of an individual who will be acting as an assistant during the visit. A healthy and safety inspection was done of the inside and outside of the home. The off limits areas include: the entire upstairs, laundry room, and garage. The licensee understand that if an off limits area is to become on limits or vice versa she will need to contact her LPA. LPA Birk-Miller observed a gate placed at the bottom of the stairs in the home. During the visit the Safe Sleep and Effects of Lead Exposure brochure were discussed and provided. LPA discussed the recent change for the blue immunization card and provided a copy.

Effective today 8/13/19, LPA is granting a license to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years. When there is no assistant present, the facility will revert back to the small capacity.

An exit interview was conducted. Notice of cite visit posted and no deficiencies cited.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
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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