343621972-12-23-2021-53-CC-JBIK-C9YUC9-20211223142733

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343621972
Report Date: 12/23/2021
Date Signed: 12/23/2021 04:36:56 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, MARY		FACILITY NUMBER:	343621972
ADMINISTRATOR:	LAWS, MARY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 879-1985
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	14	CENSUS: 3	DATE:	12/23/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Mary Laws		TIME COMPLETED:	02:40 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	On 12/23/2021 at 12:45 PM Licensing Program Analysts (LPAs) Jeevun Birk-Miller and Katy Maestas met with the licensee, Mary Laws for the purpose of an unannounced required annual inspection. The licensee's husband and children were also present during the inspection. Licensee had one infant and one preschool age child in care. Facility hours of operation are Monday through Friday from 7:00 AM to 6:00 PM. A review of the Facility Personnel Summary shows that all adults living and working in the home have criminal record clearances on file with Licensing Office. Licensee stated that no new residents moved into the home since licensure. Capacity specified on the license was met on today’s inspection. A health and safety inspection was conducted in all areas accessible to children. Off limit areas are: laundry room, garage, and two bedrooms/bathroom upstairs. LPA observed the posting of the facility license, Emergency Disaster Plan, Earthquake Preparedness Checklist and Notification of Parent Rights. Facility maintains a working phone, 2A10BC fire extinguisher, and functioning smoke/carbon monoxide detector. Licensee stated there are no weapons in the home. There are no bodies of water on the premises. Toxic and hazardous items are inaccessible to children. The fireplace in the home is appropriately barricaded to prevent access by children and outdoor play space is fenced. The stairs to the second floor is barricaded. At 1:20 PM LPAs received facility records from the Licensee, which includes children and the Licensee's files. LPA reviewed five children’s files and the Licensee's file. All required forms for the children in care are complete and maintained. LPA reviewed the licensee's immunization records for measles (MMR), pertussis (Tdap), and the flu are available in the facility. Current in person EMSA CPR and First Aid certification was verified and expires 06/17/2023. Licensee's Mandated Reporter Training AB1207 was current and expires on 07/09/2023. Current roster was available and disaster drills are conducted at least once every six months. Report continues on 809-C.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun Birk	TELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021

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: LAWS, MARY	FACILITY NUMBER: 343621972
	VISIT DATE: 12/23/2021

NARRATIVE

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Mary was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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

Exit interview was conducted and report was reviewed with Mary. No citations were given at this time. A notice of site visit was posted by the LPA and must remain posted for 30 days.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun Birk	TELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021

LIC809 (FAS) - (06/04)

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