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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500083
Report Date: 07/08/2021
Date Signed: 07/08/2021 10:47:55 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, PAULINEFACILITY NUMBER:
344500083
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
07/08/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Pauline ScruggsTIME COMPLETED:
11:00 AM
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On July 8, 2021 Licensing Program Analyst (LPA), Fabiola Diaz met with licensee, Pauline Scruggs, for the purpose of an increase of capacity inspection. Licensee applied to change from a Small Family Child Care Home to a Large Family Child Care Home. Upon entering the home, LPA observed 5 day care children present in the home. On today's date licensee's niece was present.

The one story home has an unfenced front yard, a fenced back yard, a garage, a laundry room, a classroom, a kitchen with a dining area, a living room, two bedrooms (#2 and #3), a master bedroom with a bathroom (#1), and a hallway bathroom. The off-limits areas in the home are garage, laundry room, and bedrooms #1 and #2. As of today, licensee requested to add bedroom #3 to be on-limits, and was approved by LPA. Bedroom #3 shares a wall with the dining area. Licensee updated the facility sketch and provided a copy to LPA. Licensee acknowledged that children may never enter the off-limit areas. Licensee acknowledged that if she would like to change an off-limits area to on-limits, she will inform LPA for inspection and approval prior to using the space. All adult residents have criminal record clearances.

During the inspection, LPA requested a tour of the facility. LPA and licensee conducted a health and safety tour inside and out the home. Functioning smoke and carbon monoxide detector (which licensee stated was a dual) and a fire extinguisher that meets Title 22 were observed in the home. The Fire Safety Inspection Clearance has been cleared by Cosumnes Community Services District FD as of 7/2/2021. The home does not have a fire place or stairs.

LPA observed that there were no hazardous items and cleaning supplies accessible to children. Licensee understands that any poisons must be kept under lock and key. Licensee stated there are no weapons in the home. Toys appear to be safe, and LPA discussed safety regulations of toys and play equipment. The backyard is fenced and gated with toys and play equipment.


LIC 809 continues on LIC 809C...
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
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: SCRUGGS, PAULINE
FACILITY NUMBER: 344500083
VISIT DATE: 07/08/2021
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Records, postings, fire drill and reporting requirements were discussed. LPA observed a complete children's roster and children's files. Licensee was encouraged to visit the department website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, self-assessment guides, regulations and legislation pertaining to family child care homes. Licensee was provided with the new Safe Sleep Regulations and information regarding Incidental Medical Services (IMS). On today's date LPA was provided with an updated LIC279B by licensee.

Today 7/8/21, the facility was approved for a Large Family Child Care License to serve 12 children (when there is an assistant present) with no more than 4 infants, or capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or above and 1 child at least age 6 with a maximum of 3 infants. Without assistant, the ratios revert to those for small family childcare home.

An exit interview was conducted. Appeal Rights and Notice of Site Visit were provided. LPA observed the licensee post the Notice of Site Visit. The Notice of Site Visit must remain posted for 30 days.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
LIC809 (FAS) - (06/04)
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