343623795-12-10-2020-03-CC-ESIA-BW6QP3-20201210112006

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623795
Report Date: 12/10/2020
Date Signed: 12/10/2020 11:20:14 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:	PALOMBO, SANDRA		FACILITY NUMBER:	343623795
ADMINISTRATOR:	PALOMBO, SANDRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 385-7219
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95823
CAPACITY:	14	CENSUS: 0	DATE:	12/10/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Sandra Palombo		TIME COMPLETED:	10:00 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	NOTE: Due to Covid-19 and DPH guidelines on physical distancing, a Tele-visit via FaceTime was conducted. On Thursday, December 10, 2020, at 08:30AM, Licensing Program Analyst (LPA) Elvira Sierra conducted a Prelicensing visit for the purpose of change of location. Applicant was previously license by the Peninsula Regional Office facility #214005437. LPA explained about obtaining $300,000 liability insurance. Facility hours of operation will be M-F from 07:30 AM to 05:30 PM. All individuals residing in the home have obtained a criminal record clearance. At 08:40 AM, with the help of the Applicant, a health and safety inspection was conducted and the following was observed. Home is a 3 bedrooms and 1 1/2 bathroom. Home appears orderly and suitable for children. The Off-limits areas include; Bedroom # 2 (office), Bathroom # 2, all closets, front yard and driveway. Garage has been converted to use as a play area( garage will be added to the daycare area once that approval is received from Fire Department. Applicant acknowledged that children may never enter these off-limit areas Mandated Reporter Training expires on 06/17/22, applicant understands that the training must be updated every 2 years. The fireplace in the living room or play area has been properly barricaded. Hazardous items were stored inaccessible to children in care. LPA observed cabinet latch locks in most cabinets and drawers in the kitchen and the bathroom. Fire extinguisher (2A10BC), carbon monoxide and smoke detector meet regulation. Toys appear to be safe. The backyard is fenced for supervision. Applicant understands that in unfenced area’s 100% supervision of children is required. There are no bodies of water on the premises. Applicant was advised that prior to making alterations or additions to the home or grounds, the applicant shall notify the Department of the proposed changes. Applicant rents the home and proof of lease agreement was observed. LPA received self-assessment guide and uploaded attachment to FAS. LPA confirmed COVID-19 posters have been displayed at the entry of the home with the parents rights poster. The emergency disaster plan has been updated to reflect Health Department contact information and is posted on the entrance of the home. Report continues on page 809C----

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2020

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: PALOMBO, SANDRA	FACILITY NUMBER: 343623795
	VISIT DATE: 12/10/2020

NARRATIVE

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LPA provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochures. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so applicant can request to be added to the distribution list to receive Quarterly Updates.

*LPA discussed guidance and practices regarding social and physical distancing for providers to prevent exposure to COVID-19 while providing care for children. COVID-19 Posting documents and the use of Personal Protective Equipment during COVID-19 Outbreak guidance*.

License will be granted upon receiving the following:

-Fire Clearance Approval
-Current CPR and first aid is required.
-Outdoor play area does not have enough tanbark or any type or cushioning, especially in the areas under and around the climbing equipment in the backyard.
-Need to show manufacture level or proof that the play structure in the backyard is age appropriate for the children in care.

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.** Please note: When a physical inspection takes place, requests for alterations may be made**

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2020

LIC809 (FAS) - (06/04)

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