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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622111
Report Date: 02/03/2020
Date Signed: 02/03/2020 02:22:30 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:MCCLINTOCK, NICOLEFACILITY NUMBER:
343622111
ADMINISTRATOR:MCCLINTOCK, NICOLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 768-5829
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:14CENSUS: 12DATE:
02/03/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Nicole McClintockTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lea Habtom and Jeremy McClain met with licensee Nicole McClintock for an unannounced annual/random inspection. Present at the time of inspection was licensee, her assistants Darcy Felker and Kati Clifton and 12 day care children.

A tour of the home, inside and outside, as shown on the facility sketch was conducted. Stairs are barricaded when children under age 5 years old are present. Off-limit rooms are: second floor, all bedrooms, laundry room, garage and dog run. Licensee acknowledges that children may never enter these off-limit areas.

Licensee states there are no weapons or firearms in the home. There is a swimming pool that is fenced with wrought iron fencing per regulation. LPA observed hazardous items (detergents, cleaning compounds, medication, sharp utensils, and other items that could pose a danger to children in care) are properly stored out of children's reach. Fireplace contains a screen and is inaccessible to children. There is a working telephone. Fire extinguisher, carbon monoxide detector and smoke detector meet regulations. Toys and play equipment that were observed appear to be safe.

Adequate supervision is being provided during this inspection. The capacity as specified on the license is maintained. Staff-child ratios are maintained. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Pediatric CPR/FA is current with expiration date of 12/2021. A child roster is maintained. Fire and disaster drills are conducted every six months and documented. Children records reviewed.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020
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: MCCLINTOCK, NICOLE
FACILITY NUMBER: 343622111
VISIT DATE: 02/03/2020
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LPA observed proof that licensee and staff/ volunteers have met the requirements of SB 792.

LPA observed that all staff completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com

LPA discussed the new Safe Sleep in Child Care regulation. LPA discussed and gave licensee the Effects of Lead Exposure brochure.


This facility is not providing Incidental Medical Services-IMS at this time.

Hours of operation are 7:30 AM to 4:30 PM; Monday to Friday and other hours as arranged.

Licensee states she does not transport children.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current regarding new regulations. LPA also included the email address for the child care advocates program so licensee can request to be added to the distribution list to receive Quarterly Updates. childcareadvocatesprogram@dss.ca.gov.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, NO deficiencies were observed today. This report was reviewed and discussed
with licensee at time of inspection.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020
LIC809 (FAS) - (06/04)
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