343622265-1-10-2020-03-CC-KFEA-BKPSH2-20200110125248

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343622265
Report Date: 01/10/2020
Date Signed: 01/10/2020 12:52:54 PM

COMPREHENSIVE INSPECTION

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:	CARBAJAL ATTAOUS, SARA		FACILITY NUMBER:	343622265
ADMINISTRATOR:	CARBAJAL ATTAOUS, SARA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 390-9791
CITY:	FOLSOM	STATE: CA	ZIP CODE:	95630
CAPACITY:	14	CENSUS: 9	DATE:	01/10/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Sara Carbajal Attaous		TIME COMPLETED:	01:15 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) Kelly Ferrara met with Licensee Sara Carbajal Attaous for an unannounced random annual inspection of her large family child care home. All adults who live or work in the home have obtained a criminal record clearance. Hours of operation are Monday through Friday 6:30 AM- 5:30 PM and the annual fees are current. There were nine children present at the time of inspection with the Licensee and two assistants. Licensee understands that she must revert back to a small license when no assistants are present. A health and safety inspection was conducted in all areas accessible to children. Off limit areas include: Bedrooms 1 and 2, master bathroom, garage, and laundry room. LPA observed a working phone, 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors that meet regulations. LPA observed a first aid kit, current children's roster, and fire drill log with the last drill conducted on December 11th, 2019. LPA observed all the required Licensing documentation was posted including Parent's Rights, Emergency Disaster Plan, facility sketch, and the license. Knives, medications, and chemicals were all stored inaccessible to children in kitchen cabinets. LPA did not observe any bodies of water on the premises and Licensee stated there are no firearms in the home. LPA conducted a staff and children's file review. The Licensee and each of the staff have the required Licensing documents, proof of immunizations, and the Mandated Reporter certification. LPA advised that this training must be completed every two years. The Licensee has a valid CPR/First Aid certificate which expires in August 2021 and the assistants' expires in January 2021. LPA observed that all of the required documentation was present in each child's file. LPA advised that the public health form for children's immunization record has changed and will be required for newly enrolled children.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020

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: CARBAJAL ATTAOUS, SARA	FACILITY NUMBER: 343622265
	VISIT DATE: 01/10/2020

NARRATIVE

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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.

Effects of Lead Exposure and Safe Sleep brochures were given to the Licensee. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. The facility evaluation report was reviewed and discussed and a copy of this report will remain on file for a period of 3 years for public review upon request. Notice of site visit was provided and it must remain posted for 30 days for parental review.

No citations were issued based on today's inspection.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020

LIC809 (FAS) - (06/04)

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