343624027-12-8-2021-03-CC-BMOS-C9HVJW-20211208152925

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624027
Report Date: 12/08/2021
Date Signed: 12/08/2021 03:29:30 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:	BLAKESLEE, TALINA		FACILITY NUMBER:	343624027
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	12/08/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Talina Blakeslee - Licensee		TIME COMPLETED:	03:45 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 Wednesday, December 8th, 2021, at 1:54pm, Licensing Program Analyst (LPA) Blake Morillas conducted a Case Management visit for the purpose of increasing capacity from 8 to 14 children. At 1:54pm LPA informed the Licensee, Talina Blakeslee, of the reason for the inspection. No day care were present during the time of the inspection, however the Licensee's spouse and two children were present. Licensee stated there are no new residents in the home. Adult residents have criminal record clearances. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Off-limits areas include the All Bedrooms, Master Bathroom. During the visit, at the request of the Licensee, all Outbuildings were added to the Off Limit areas. Licensee acknowledged that children may never enter these off-limit areas. LPA observed current CPR/First Aid certificates (expires: 8/2023), posted License, Parent's Rights and current emergency disaster plan. A current roster of the enrolled children and fire drill log was observed. The Fire Safety Inspection Clearance has been received and the home has been cleared for up to 14 children. Continued on LIC 809-C

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake Morillas	TELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: BLAKESLEE, TALINA	FACILITY NUMBER: 343624027
	VISIT DATE: 12/08/2021

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
26
27
28
29
30
31
32

Continuation of LIC 809

Hazardous items were stored inaccessible to children in care.

Licensee stated there are no weapons in the home. There is a wood burning stove in the home that is appropriately barricaded according to Title 22 regulations.

Fire extinguisher (2A10BC), carbon monoxide and smoke detector meet regulations.

Toys appear to be safe. The backyard is fenced. The Licensee understands that in unfenced area’s 100% supervision of children is required.

There is a pool at the home. The swimming pool in the backyard is fenced with a self-latching and self-closing gate.

Current Covid-19 guidelines were provided and discussed with with Licensee

Licensee understands that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

Capacity increase is approved as of today, 12-8-2021.

The facility is licensed to serve a MAX. CAP(WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

At 3:23pm, LPA reviewed and discussed this facility evaluation report with the Licensee.

Notice of site visit posted.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake Morillas	TELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2