393610611-3-20-2023-53-CC-CBEY-CQ4VSD-20230320164122

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393610611
Report Date: 03/20/2023
Date Signed: 03/20/2023 04:41:39 PM

Document Has Been Signed on 03/20/2023 04:41 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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	THOMAS, JACQUELINE & TERRY		FACILITY NUMBER:	393610611
ADMINISTRATOR:	THOMAS, JACQUELINE & TERRY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 835-7801
CITY:	TRACY	STATE: CA	ZIP CODE:	95377
CAPACITY:	14	CENSUS: 14	DATE:	03/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Jacqueline Thomas		TIME COMPLETED:	05:00 PM

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On 3/20/23, Licensing Program Analyst (LPA), Corina Beckby met with both Licensee's, Jacqueline and Terry Thomas for an unannounced Annual inspection. Present in the home were Licensee's Jacqueline and Terry Thomas and 2 assistants supervising 14 children. (Ages: 1 yo, 2 yo, 2 yo, 2yo, 2 yo, 3 yo, 4 yo, 4yo, 4yo, & 5 school age kids) Day care hours of operation are Monday-Friday 6:00 AM to 6:30 PM. LPA verified annual fees are current.

Licensee's stated there are no new residents in the home which is a 2 story, 6 bedroom, 3 bathroom home. All adults living in the home have criminal background clearance. 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.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas are: entire second floor, garage and laundry room. Off limit areas are being made inaccessible by closed/locked doors, gates and/or supervision. Licensee acknowledgesthat children may never enter these off-limit areas.
LPA observed hazardous items properly stored out of child reach. There were no hazardous items located in the bathroom. Medication is stored on the top cabinet above the refrigerator. LPA observed the required postings and a working phone, and a 3A40BC fire extinguisher meeting regulations. LPA observed smoke and carbon monoxide detectors, and verified they were both functional. LPA toured the kitchen area and verified knives were inaccessible to children in care.

Continues LIC 809C

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina Beckby	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023

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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: THOMAS, JACQUELINE & TERRY	FACILITY NUMBER: 393610611
	VISIT DATE: 03/20/2023

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LPA observed cleaning supplies properly stored in the laundry room in a locked cabinet with child safety lock. Toxins and hazardous items are inaccessible to children. Licensee stated there are no weapons in the home. There are no bodies of water on the premises. The fireplace is blocked off and not in use. Outdoor play area is free of hazardous and dangerous conditions and is fenced off and there is constant supervision while the children are outside. Backyard has a trampoline that is used by children according to age and is supervised when in use. Licensee understands that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes.

A sample of children’s files were reviewed and determined to be in compliance with licensing requirements. Current pediatric CPR and first aid certification was verified and expires on 10/2024. Licensee has current mandated reporter certificate and expires on 2/28/25. LPA discussed the California Child Care Worker: Mandated Reporter Training with the licensee's. Licensee understands Mandated Reporter Training must be completed every two years starting January 1, 2018, and retain proof of completion in the facility file. The training can be found at: mandatedreporterca.com.

Licensee understands that if anyone else works with the children, they must also obtain the following: EMSA approved or American Red Cross or American Heart Association CPR and first aid training, immunization for TB, Measles, Pertussis and Influenza, and complete AB1207 Mandated Reporter Training.

In addition, LPA discussed the infant sleep regulations with licensee. LPA discussed the requirement to check and log infant napping every 15 minutes for infants up to 24 months and under. LPA discussed the safe sleep regulations with licensee 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.

Continues LIC809C

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina Beckby	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023

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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: THOMAS, JACQUELINE & TERRY	FACILITY NUMBER: 393610611
	VISIT DATE: 03/20/2023

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This provider is currently not providing Incidental Medical Services (IMS) services to children in care. IMS policy was discussed with Licensee. 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.

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/inspection-process

Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the licensee can request to be added to the distribution list to receive Quarterly Updates.

An exit interview was conducted, and report was reviewed with the licensees, Jacqueline and Terry Thomas. A copy of this report will remain on file for a period of three years for public review upon request. Licensee's signature on this form acknowledges receipt of this form. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina Beckby	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023

LIC809 (FAS) - (06/04)

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