343623730-11-2-2020-03-CC-JHOA-BUZ22J-20201102160048

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623730
Report Date: 11/02/2020
Date Signed: 11/02/2020 04:00:57 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:	STRICK,RACHAEL		FACILITY NUMBER:	343623730
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	11/02/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Rachael Strick		TIME COMPLETED:	03:00 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	On 11/2/20 at 12:30pm, due to COVID-19 pandemic, Licensing Program Analyst (LPA), Jan Hoshida, met with Applicant, Rachael Strick, via Zoom for the purpose of a pre-licensing inspection. All individuals subject to criminal background review have obtained a criminal record clearance. During the Zoom inspection, LPA Hoshida requested a tour of the facility. LPA and Applicant conducted a health and safety inspection inside and outside of the home. The two-story has an unfenced front yard, three bedrooms, three bathrooms, playroom, kitchen, dining room with living area, laundry room, loft, garage and fenced back yard. The off-limits areas in the home are the master bedroom and bathroom, son’s bedroom, laundry room, garage and outside dog run on the right side of the house. Off-limits areas will remain inaccessible to children by closed doors and/or supervision. Functioning smoke and carbon monoxide detectors and fire extinguisher were observed in the home. Preventative health and safety, current pediatric CPR and first aid training was verified and expires on 10/11/2022. No weapons in the home. There is an electric fireplace within the home that is unplugged and the Applicant stated is not in use. Supervision was discussed and applicant understands that children must be 100% supervised in unfenced yards and areas. Immediate Civil Penalty regulation and deficiencies were reviewed. Licensing documents were observed in the front playroom of the home. Applicant has a dog that will be placed in the outside dog run during day care hours. Applicant will be offering day care services from Monday through Friday from 6:00 am to 6:00 pm. Applicant acknowledged that she must place her poisons to be inaccessible and under lock and key. Applicant stated that she will be placing the poisons in the outside shed. LPA observed an outside fire pit that is fueled by natural gas and has fire glass within the pit. Applicant stated that she has purchased a cover for the fire pit. Applicant stated that she will send pictures to LPA to prove her poisons are under lock and key and a the outdoor fire pit is covered and inaccessible to children. *REPORT CONTINUED ON NEXT PAGE*

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2020

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: STRICK,RACHAEL	FACILITY NUMBER: 343623730
	VISIT DATE: 11/02/2020

NARRATIVE

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LPA consulted applicant regarding the following topics: new upcoming regulations, Type A vs. Type B deficiencies, complaints, LPA’s right to interview children without parental consent, civil penalties, incidental medical services, placement of detergents, placement of poisons, placement of medicines, announced vs. unannounced inspections, posting requirements, unusual incident reports, on-limits vs. off-limit areas, licensing file management, fire drills, 80% supervision, 100% supervision, fingerprint clearances, advertising, mandated reporting and best practices.

LPA consulted the applicant regarding personal rights. Applicant understands that corporal, physical and/or unusual forms of punishment is never allowed toward day care children or their own children during day care hours.

LPA discussed the Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care Home must have vaccinations against, Pertussis, Measles and Influenza. Proof of required vaccines have been obtained from the Applicant.

LPA explained the requirement of AB1207 Mandated Reporter training. LPA explained that training must be completed once every two years.

Applicant understands that anyone living or working in the home, eighteen years of age or older must obtain fingerprint clearance PRIOR to living or working in the home. Applicant understands that if anyone else works with the children, must also obtain the following: EMSA certified CPR and first aid training if left alone with the day-care children, and immunization for Measles, Pertussis and Influenza, and complete AB1207 Mandated Reporter Training.

Applicant understands that a current roster must be maintained and that a fire drill must be conducted and documented once every six months.

Applicant understands that her FCCH license is not transferable, and once licensed, Applicant must live in the home and be present for 80% of the operating hours. LPA explained to Applicant that if she moves and wants to continue to provide care, she must submit a change of location application and have the new home inspected again.

Applicant understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the written Unusual Incident Report (LIC 624) shall be submitted within seven days to remain in compliance.

REPORT CONTINUED ON NEXT PAGE

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2020

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: STRICK,RACHAEL	FACILITY NUMBER: 343623730
	VISIT DATE: 11/02/2020

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Applicant understands that if she wants to make any changes to on or off limit areas in the home, she must notify licensing and LPA must do an inspection BEFORE children are allowed in the areas.

Applicant understands that children’s records are to be maintained according to Title 22 Regulations and be accessible to licensing for up to three years. Licensee understands that her License, Emergency Disaster Plan, and the Parents Rights Poster must be posted in the home.

This facility plans to provide Incidental Medical Services (IMS). 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

This facility evaluation report was reviewed and discussed with the Applicant. Records, postings and reporting requirements were discussed. The Records To Be Maintained At The Facility - Family Child Care Home (LIC311D) was provided and discussed. 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. LPA also included the email address for the children's advocacy program to stay current on new laws CHILDCAREADVOCATESPROGRAM@DSS.CA.GOV.

The following to be submitted prior to licensure:

1. Proof of poisons inaccessible and under lock and key

2. Proof that outdoor fire pit is covered and inaccessible to children

Upon final review of file, proof of poisons inaccessible and under lock and key and proof that the outdoor fire pit is covered and inaccessible to children, LPA will recommend facility 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 with no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6. An exit interview was conducted and Notice of Site Visit was provided.

Facility evaluation report was emailed to Applicant and an email verification of receipt of report will be used in lieu of a signature on this report.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2020

LIC809 (FAS) - (06/04)

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