343622577-4-27-2022-03-CC-JGAG-CDVMGJ-20220427093600

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343622577
Report Date: 04/27/2022
Date Signed: 04/27/2022 09:36:09 AM

Document Has Been Signed on 04/27/2022 09:36 AM - It Cannot Be Edited

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:	MILLER, JULIETTE		FACILITY NUMBER:	343622577
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	04/27/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Juliette Miller		TIME COMPLETED:	09:45 AM

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On April 27, 2022 at approximately 8:25 AM Licensing Program Analyst (LPA) Josiah Gathing met with Licensee Juliette Miller. Licensee applied for a capacity increase from 8 to 14 children in care. During the inspection, The applicant and applicant’s husband were present.

A health and safety inspection was conducted inside and out of the home. The single-story facility includes 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, family room, garage, an unfenced front yard and fenced backyard with in-ground swimming pool. The swimming pool is fenced to meet requirements with a self-latching gate. Applicant acknowledged that that the fence will remain in place whenever licensed care is provided, and so long as the fence makes the swimming pool, body of water, or other hazards inaccessible to children. The off-limits areas are bedroom #3, bathroom #2, family room, and garage. Applicant acknowledged that off-limits areas will remain inaccessible to children by closed doors and supervision.

The fireplace is barricaded to be inaccessible to children. Toxic and hazardous items are inaccessible to children. Applicant stated there are no weapons or poisons in the home. Sharp knives are stored in the kitchen, on the refrigerator, out of children's reach. Medications are stored out of children’s reach. A first aid kit was observed in the home. LPA observed all required licensing postings near the facility entrance.

LPA observed functioning smoke and carbon monoxide detectors and a pull fire alarm. A full 3-A:40-B:C fire extinguisher was also observed in the home. The house was inspected by local fire marshal and the clearance was granted on April 19, 2022. During the inspection LPA informed licensee of the ratio and capacity requirements of large family home license. Licensee stated that she understands the requirements.

Cont. on LIC809-C...

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Josiah Gathing	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

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: MILLER, JULIETTE	FACILITY NUMBER: 343622577
	VISIT DATE: 04/27/2022

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Licensee provided Preventative Health and Safety training certificate with Lead Poison Prevention approved 8/17/2021. Licensee provided current pediatric CPR and first aid training with an expiration of 11/10/2023. Mandated Reporter certificate was also provided with an expiration of 11/01/2023. Supervision was discussed and applicant understands that children must be 100% supervised in unfenced yards. Immediate Civil Penalty regulation and deficiencies were reviewed.

In the areas that were evaluated, no deficiencies were observed at the time of the inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and this report was reviewed and provided to the Licensee, Juliette Miller.

Capacity increase is approved as of today, April 27, 2022. The facility is licensed to serve a MAX. CAP (WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Josiah Gathing	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

LIC809 (FAS) - (06/04)

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