343623370-9-16-2021-03-CC-GSIH-C6WRDA-20210916125534

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623370
Report Date: 09/16/2021
Date Signed: 09/16/2021 12:55:36 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:	KILMER, ADRIANNA		FACILITY NUMBER:	343623370
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	09/16/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Jenelle Davis & Adrianna Kilmer		TIME COMPLETED:	01:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Gagandeep Singh met with the assistant helper, Jenelle Davis, for a case management inspection. The licensee has applied for a capacity increase from eight to fourteen children in care. Purpose of the today’s inspection was to inspect the house for any health and safety hazards. Licensee arrived at the facility during the inspection.

During the inspection, LPA inspected the day care areas. LPA observed the licensee has license and other required documents posted and are visible for public. There are no pools, spas or other bodies of water. The house has proper temperature and ventilation. The fireplace is barricaded and is inaccessible for the children. Furniture with sharp corners has cushion materials attached to the edges. There is carbon monoxide detector, smoke alarm, smoke pull alarm, fully charged fire extinguisher and first aid supplies available in the house.

During inspection, LPA discussed the capacity and ratio regulations for a large family child care license with the licensee and a handout was provided. LPA reminded the licensee that fire/earthquake drills are to be conducted every 6 months and recorded. LPA discussed the safe sleep regulations for the infants and provided the copy of PIN 20-24-CCP. LPA also provided a copy of LIC9227 – Individual Infant Sleeping plan form. Licensee has record of CPR training valid until October 2021 and record of completion of Mandated reporter training valid until November 2021.LPA reminded the licensee that all adults, 18 years and older living in the home, helper or assistant must have criminal record clearance and must be associated to the facility prior to having any contact with children in care. Failure to do so could result in an immediate civil penalty of $100.00 each day.

During the inspection, LPA did not observe any hazards. Prior to grant the license, the licensee must have the house inspected by the local fire department and have it approved. Per licensee, licensee has been reaching out to the fire department, but has not got the house inspected yet.

No deficiencies are cited today. Copy of this report is reviewed and provide to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

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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