343623767-11-10-2020-03-CC-LHAM-BV8W59-20201110155846

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623767
Report Date: 11/10/2020
Date Signed: 11/10/2020 04:02:46 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:	PARKER, MARK		FACILITY NUMBER:	343623767
ADMINISTRATOR:	PARKER, MARK		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(219) 384-1228
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	14	CENSUS: 0	DATE:	11/10/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Mark Parker		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	Due to COVID-19 Licensing Program Analyst (LPA) Habtom was unable to complete the pre-licensing visit based on normal practice of an unannounced inspection. LPA Habtom conducted a televisit using facetime on November 10, 2020 at 2:00 pm with the licensee Mark Parker. LPA Habtom met with applicant Mark Parker for a pre-licensing inspection. There were no children present during today's inspection. Also present today was licensee’s daughter, Natalia Boyko. LPA toured the 4 bedrooms, 2 bathrooms two story home inside and out. Hours of operations is 24 hours and licensee plans on transporting children. One mini van vehicle was observed in the drive way. Applicant is the only person residing in the home. LPA explained that any new residents that move into the home must be fingerprint cleared and the Licensing Agency must be notified prior to them residing in the home. LPA reviewed forms for children's records. LPA received confirmation for control of property. Licensee obtained $300,000 liability insurance. Applicant has certificates of completion for 16 hours of health and safety training including CPR and First Aid with expiration date of 2/2022. Mandated reporter training was verified with an expiration date of 2/2022. All adult residents received criminal record clearances and proof of TB clearance. LPA reminded applicant of the applicable Civil Penalty per person for those adults, including your own child, who have not received fingerprint clearances, are not associated to the license, come in contact with and or provide care and supervision to the children. LPA provided the Community Care Licensing’s website www.ccld.ca.gov, to obtain updated licensing information, new regulations and access forms. LPA advised the applicant of their responsibility to stay current regarding new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov. Continued on the following page LIC 809-C

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea Habtom	TELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2020

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: PARKER, MARK	FACILITY NUMBER: 343623767
	VISIT DATE: 11/10/2020

NARRATIVE

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Applicant understands that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes. The shed in the backyard is locked with a lock and a key. Off-limit areas include: kitchen, upstairs room, upstairs bathroom and garage. Applicant understands that children may never enter these off-limit areas. LPA reviewed the fire drill requirements. The fire place contains a screen. Applicant stated there are no weapons in the home. LPA observed a 2A10BC fire extinguisher. LPA observed and tested a dual working carbon monoxide and smoke detector. Hazardous cleaning compounds are inaccessible to children. Sharp utensils and medications are inaccessible to children. The backyard is fenced and there are no bodies of water observed.

LPA observed proof that licensee and staff/ volunteers have met the requirements of SB 792.

LPA observed that all staff has completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com

LPA discussed the new Safe Sleep in Child Care regulation and gave licensee the brochure. LPA discussed and gave licensee the Effects of Lead Exposure brochure.

(LARGE ) Effective today 11/10/2020, Applicant is approved for a large license to serve up to either 14 children, two (2) of which must be at least 6 years of age and no more than three (3) may be infants; or 12 children, four (4) of which may be infants. Infants are children under the age of 2

Exit Interview conducted and notice of site visit provided.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea Habtom	TELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2020

LIC809 (FAS) - (06/04)

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