393610744-3-9-2020-53-CC-GSIH-BMJU3T-20200309151405

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393610744
Report Date: 03/09/2020
Date Signed: 03/09/2020 03:14:16 PM

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:	DUCK, DIANNE		FACILITY NUMBER:	393610744
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	03/09/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Dianne Duck & Timothy Duck		TIME COMPLETED:	03:30 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	Licensing Program Analyst (LPA) Gagandeep Singh met with licensee, Dianne Duck, and her husband, Timothy Duck, for an annual inspection. The purpose of the inspection was explained. Licensee lives in a single story home. Present, there are six children (five pre school age and one school age) in care with licensee and her husband. All adults living or working in the home have criminal background check on file. Licensee is operating within the capacity of this date. LPA inspected the day care areas with the licensee. Day Care Areas: Family room, Kitchen, Living Room, Bathroom in Hallway and Backyard. Off limit areas: All bedrooms, Office and Garage. All doors to the off limit areas have child protective locks installed. There is no pool, spa or any other body of water in the house. As per licensee, there is no firearm or weapon in the house. All the cleaning supplies, and other chemicals are stored inaccessible to the children. All cabinets in kitchen with chemicals have child protective locks installed. Knives in the kitchen are stored on high counter and are inaccessible for children. The house is in good repair and free of hazards with proper temperature and ventilation. There is carbon monoxide detector, smoke detector, fully charged fire extinguisher and working telephone available in the house. There is a variety of age appropriate toys in the house. LPA review the facility records. LPA reviewed the identification and emergency information form for every child for proper names and numbers filled. Licensee has immunization records on file for each child in care. Licensee has record of training of preventive health and CPR card valid until October 2020. LPA remind the licensee to conduct the fire or emergency drills at least once every six months and drills must be logged. Licensee has a log in place. Per log, last drill was conducted in October 2019. Licensee has well maintained roster on file. Department has record of immunization of licensee and all adults living in the house. See next page for continuation ................

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2020

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: DUCK, DIANNE	FACILITY NUMBER: 393610744
	VISIT DATE: 03/09/2020

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Continuation from pervious page .................

Licensee is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificate of licensee, her husband and licensee’s children.

LPA discussed the effects of lead exposure and a brochure was provided to handout to the parents. LPA encourage the licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

No deficiencies are cited today. The copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2020

LIC809 (FAS) - (06/04)

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