344500083-1-23-2020-53-CC-FDIZ-BL4PKL-20200123102319

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 344500083
Report Date: 01/23/2020
Date Signed: 01/23/2020 10:23:47 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:	SCRUGGS, PAULINE		FACILITY NUMBER:	344500083
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	01/23/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Pauline Scruggs		TIME COMPLETED:	10:35 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) Fabiola Diaz met with Applicant Pauline Scruggs for the purpose of an announced pre-licensing inspection. During the inspection Applicant’s grandchild was also present. All individuals subject to criminal background review have obtained a criminal record clearance. A health and safety inspection was conducted inside and out. The one story home has an unfenced front yard, a fenced back yard, a garage, a laundry room, a play room, a kitchen with a dining area, a living room, two bedrooms, a master bedroom with a bathroom, and a hallway bathroom. The off-limit areas in the home are the garage, all bedrooms, and laundry room. Off-limit areas will remain inaccessible to children by closed doors and/or supervision. Applicant acknowledges that she must contact Community Care Licensing prior to making an off-limits area on-limits and vice versa. Applicant understands that if any structural changes are made to the home, licensing must be notified prior to construction. The home does not have a fireplace. There are no large bodies of water on the premises.Applicant stated there are no weapons in the home. Toxic and hazardous items are inaccessible to children. Safety door knobs are in use on pantry and laundry room doors. Applicant understands that they must ensure the safety knobs are not broken. LPAs observed poisons are kept in the garage and locked away. Applicant understands all poisons must be locked with a key lock or combination lock. Functioning smoke and carbon monoxide detectors and a 2A10BC fire extinguisher were observed in the home. Applicant is encouraged to maintain supervision at all times. Type A/B citations and Immediate Civil Penalty regulation deficiencies were reviewed. 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 Unusual Incident Report (LIC 624) shall be submitted within seven days.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola Diaz	TELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020

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: SCRUGGS, PAULINE	FACILITY NUMBER: 344500083
	VISIT DATE: 01/23/2020

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

Preventative Health, current pediatric CPR and first aid training was verified and expires on 07/2021. Applicant has completed the required AB1207 Mandated Reporter training. Applicant understand that the training must be completed once every two years, and training is accessible at www.mandatedreporterca.com.

Incidental Medical Services (IMS) policy was discussed. 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 provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the applicant can request to be added to the distribution list to receive Quarterly Updates.

This facility evaluation report was reviewed and discussed with the applicant. LIC 311D, records, postings, and reporting requirements were discussed. LPA discussed supervision, personal rights, criminal record clearances, staffing ratios and capacity, and maintaining buildings and grounds. Applicant was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes. LPA provided and discussed the Safe Sleep in Child Care brochure and the Effects of Lead Brochure.

Effective today, 1/23/2020, facility is approved for a Small Family Child Care Home license for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.
An exit interview was conducted. A copy of this report was given to the Applicant to keep on file at the facility for three years.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola Diaz	TELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2