343624219-2-25-2022-03-CC-MPAL-CBYUME-20220225144211

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624219
Report Date: 02/25/2022
Date Signed: 02/25/2022 02:42:40 PM

Document Has Been Signed on 02/25/2022 02:42 PM - It Cannot Be Edited

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:	KING, KRYSTAL		FACILITY NUMBER:	343624219
ADMINISTRATOR:	KING, KRYSTAL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 917-2520
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95835
CAPACITY:	14	CENSUS: 0	DATE:	02/25/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:57 AM
MET WITH:	Krystal King		TIME COMPLETED:	10:45 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	Licensing Program Analyst (LPA) Michelle Pascual met with licensee, Krystal King for the purpose of an announced pre-licensing, change of location inspection on February 25^th, 2022. A health and safety inspection was conducted inside and out. The two-story house has 3 bedrooms, 2 bathrooms and a theater room upstairs. Downstairs, there is a living room and dining room which will be the day care room, a family room, kitchen, laundry room, one bedroom and one bathroom. OFF LIMIT AREAS: Entire upstairs, downstairs laundry room and bedroom and garage. Off-limits areas will remain inaccessible to children through supervision and child gates. The applicant acknowledges that she must contact LPA prior to making an off-limits area on-limits and vice versa. Toxic and hazardous items are inaccessible to children. Functioning smoke and carbon monoxide detectors were witnessed and tested and the applicant has a fully charged fire extinguisher. There are no bodies of water on the premises. Applicant knows that 100% supervision must be provided when children are playing outside. Medications and toxic items are stored and locked away as well as knives and sharp items in the kitchen. Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

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: KING, KRYSTAL	FACILITY NUMBER: 343624219
	VISIT DATE: 02/25/2022

NARRATIVE

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LPA verified current in-person EMSA pediatric CPR and First Aid certification (exp 03/23) as well as mandatory Reporter (exp 12/22).
Training. Type A/B citations and Immediate Civil Penalty regulation deficiencies were reviewed.

Incidental Medical Services (IMS) policy was discussed and is not currently being provided. 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

LPA discussed the safe sleep regulations with applicant, licensee, or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, licensee, or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

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: KING, KRYSTAL	FACILITY NUMBER: 343624219
	VISIT DATE: 02/25/2022

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LPA reviewed with Licensee the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Licensee.

Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of 3 years for public review upon request. Their signature on this form acknowledges receipt of this form

As of 02/25/2022 the home is licensed for a large family childcare.
A large family day care home may provide care for more than 12 children and up to and including 14 children, if all of the following conditions are met:
(a)At least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age.
(b)No more than three infants are cared for during any time when more than 12 children are being cared for.
(c)The licensee notifies a parent that the facility is caring for two additional school age children and that there may be up to 13 or 14 children in the home at one time.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

LIC809 (FAS) - (06/04)

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