343623172-7-16-2019-03-CC-KGOL-BE5PKM-20190716112321

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623172
Report Date: 07/16/2019
Date Signed: 07/16/2019 11:23:30 AM

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:	RICHARDSON, ANGELA		FACILITY NUMBER:	343623172
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	07/16/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Angela Richarson		TIME COMPLETED:	11:45 AM

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) Kristal Goodell met with applicant, Angela Richardson for the purpose of a Pre-licensing Inspection. All individuals subject to criminal background review have obtained a criminal record clearance. The facility hours of operation will be Monday-Friday 7am-6pm. Applicant acknowledged Child Care shall be provided in the providers own home, for periods of less than 24 hours a day, while the parents are away. LPA toured all areas of the home. The two story home has a unfenced front yard, 6 bedrooms, 3 bathrooms, a living room, family room, dining area, kitchen, laundry room, garage, and fenced backyard. The off-limits areas in the home are entire upstairs, laundry room and garage. Off-limit areas will remain inaccessible to children by closed doors and/or supervision. Applicant acknowledged that prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed including any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. Reporting Requirements were also discussed. Functioning smoke and carbon monoxide detectors and a 2-A:10-B:C fire extinguisher were observed in the home. Preventative Health, current pediatric CPR and first aid training was verified and expires 2/2/2021. No weapons in the home or bodies of water. LPA observed "Bug Stop" in the garage. Applicant acknowledged that storage areas for poisons, firearms and other dangerous weapons shall be locked. Therefore during inspection applicant relocated poisonous item in an area with a lock. Report continues on LIC 809-C

SUPERVISOR'S NAME: Jennifer Brekke	TELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

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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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: RICHARDSON, ANGELA	FACILITY NUMBER: 343623172
	VISIT DATE: 07/16/2019

NARRATIVE

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The Mandated Reporter Training was discussed. Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. In addition, effective January 1, 2018: Applicants must meet requirements as a precondition to licensure, existing licensees must meet requirements by March 30, 2018, new employees shall have 90 days from date of employment to complete training as required. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/.

Records, postings and reporting requirements were discussed. The Records To Be Maintained At The Facility - Family Child Care Home (LIC311D) was issued. Applicant was encouraged to visit the department website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, self-assessment guides, regulations and legislation pertaining to family child care homes. This facility evaluation report was also reviewed and discussed with applicant.

Effective 7/16/19, facility is approved for a small family child care home license to serve a capacity of 6 children with no more than 3 infants or 4 infants only. Or with a capacity of 8 children: no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6.

SUPERVISOR'S NAME: Jennifer Brekke	TELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

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: RICHARDSON, ANGELA	FACILITY NUMBER: 343623172
	VISIT DATE: 07/16/2019

NARRATIVE

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Supervision was discussed, and applicant understands that children must be 100% supervised in unfenced yards. During inspection LPA observed shovels in the backyard. Applicant acknowledged hazardous items must be inaccessible to children. Therefore, during inspection applicant relocated shovels to an area inaccessible to children. Immediate Civil Penalty and deficiencies were discussed. LPA observed a gas fireplace in the family room. Applicant stated fireplace is not used. Applicant also acknowledged that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a).

LPA discussed the Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care facility must have vaccinations against, Pertussis, Measles and Influenza. LPA advised licensee that staff can sign a declaration to be exempt from the influenza vaccinations however; Pertussis and Measles are not exemptible. To be exempt from Pertussis and Measles staff must have a medical exemption signed by a licensed physician.

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

Report continues on LIC 809-C

SUPERVISOR'S NAME: Jennifer Brekke	TELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

LIC809 (FAS) - (06/04)

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