<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393602276
Report Date: 12/20/2022
Date Signed: 12/20/2022 12:12:00 PM


Document Has Been Signed on 12/20/2022 12:12 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:CARLSON, SARAHFACILITY NUMBER:
393602276
ADMINISTRATOR:CARLSON, SARAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 298-9554
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:14CENSUS: 0DATE:
12/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Sarah CarlsonTIME COMPLETED:
12:35 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 December 20,2022, Licensing Program Analyst (LPA) Elvira Sierra met with the licensee, Sarah Carlson. Facility hours of operation are M-F from 05:30 am to 08:30am and then 11:30am to 05:30pm. A review of the Facility Personnel Summary shows that all adults living and working in the home have criminal record clearances on file with Licensing Office. Licensee stated that no new residents moved into the home since licensure. Upon arrival to the facility there were no children present. Licensee's husband was also present during the inspection caring their granddaughter. No dayare children were present during the inspection.

A health and safety inspection was conducted in all areas accessible to children. Off limit areas are: Previously; Master bedroom and bathroom (inside master bedroom), bedroom #2, and backyard. Licensee is requesting to make all bedrooms off limits on today's inspection, Kitchen, and Living room area will be only used as a transition to the children's bathroom. Also Licensee stated that she likes the backyard to be accessible to the children. Licensee stated that the iron fence that surrounds the swimming pool has been fixed. LPA inspected the backyard and observed backyard is free of any hazards and suitable to children. LPA also observed the iron fenced surrounding the swimming pool is in good repair and meet Title 22 regulations. Licensee was reminded that day care children may never enter these off-limit areas. LPA observed the posting of the facility license, Emergency Disaster Plan, Notification of Parent Rights and Earthquake Disaster Checklist. Facility maintains a working phone, 2A10BC fire extinguisher, and functioning smoke/carbon monoxide detector. Age appropriate toys and reading material were observed in the daycare area. There is a weapon in the home that is stored according to regulations. Toxic and hazardous items are inaccessible to children. Chimney is located in the off limit living room. Licensee provides meals and snacks to the children and she is enrolled with the food program. Licensee transports children. Licensee acknowledges that only drivers licensed for the type of vehicle to be operated shall be permitted to transport children in care, the manufacturer's rated seating capacity of the vehicle shall not be exceeded, motor vehicles used to transport children in care shall be maintained in safe operating condition, and all vehicle occupants must be secured in an appropriate restraint system.
Report continues on subsequent page 809C--
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2022
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: CARLSON, SARAH
FACILITY NUMBER: 393602276
VISIT DATE: 12/20/2022
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
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.

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 discussed the safe sleep regulations 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 Licensee 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and posted. Notice of Site Visit must remain posted for 30 days. Exit interview conducted and this report and Appeal of Rights were reviewed and provided to the Licensee, Sarah Carlson.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2