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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393616871
Report Date: 01/18/2023
Date Signed: 01/18/2023 01:44:06 PM


Document Has Been Signed on 01/18/2023 01:44 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:FACHA, VARNAFACILITY NUMBER:
393616871
ADMINISTRATOR:FACHA, VARNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 834-2395
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY:14CENSUS: 12DATE:
01/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Varna FarchaTIME COMPLETED:
02:00 PM
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On January 18, 2023, Licensing Program Analyst (LPA’s) Corina Beckby and Stacy Williams met with licensee, Varna Facha for the purpose of an unannounced annual random inspection. Facility hours of operation are Monday through Friday 8:30-12:30pm

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. Licensee stated there are no new residents in the home since the last inspection on 01/06/2020. All individuals subject to a criminal background review have obtained a criminal record clearance. Capacity specified on the license was met during today’s inspection. Present in the facility were12 children, and 1 assistant .LPA’s verified the annual fees are not current. Licensee stated she would make payment today, 1/18/2023.

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 of the home accessible to children in care. The facility is a two-story home with 5 bedrooms, 3 bathrooms, kitchen, nook, garage, laundry room, Family room, Living room, and 2 preschool areas. Upon entry, LPA’s observed the posting of the facility license, Emergency Disaster Plan, Earthquake Preparedness Checklist and Notification of Parent Rights. LPA also observed a current roster. Fire drill log was observed; however, last drill was not conducted within 6 months of the last drill. EMSA CPR and First Aid certification was verified and expires on 2/2023.



Report continues on LIC 809-C
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina BeckbyTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2023
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 6


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: FACHA, VARNA
FACILITY NUMBER: 393616871
VISIT DATE: 01/18/2023
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 AB 1207 Mandated Reporter Training was reviewed with Licensee. LPA's discussed the requirement to renew the mandated reporter training every two years and provided the Mandated Reporter training website: www.mandatedreporterca.gov.

The facility maintains a working phone, 3A40BC fire extinguisher, and functioning smoke and carbon monoxide detectors. Hazardous and personal hygiene items are inaccessible to children in care with safety locks. Sharp utensils are stored in an upper kitchen cabinet drawer. The stairs are blocked off with a gate. There are 5 pets in the home (1 golden retriever, 1 Pomeranian dog, 2 cats, and a fish.) Dogs are crated during business hours. The fireplace is not in use during business hours. Licensee stated there are no weapons in the home. The outdoor play space is fenced. There is a pool that is fenced off meeting regulatory requirements including a self-latching gate.Toxic and hazardous items are inaccessible to children. Outdoor play space is fenced. Off-limits areas include garage, upstairs, and entire backyard. Licensee acknowledged that children may never enter these off-limits areas and that off-limit areas will remain inaccessible by locked doors, gates and supervision. Toys are age appropriate.

LPA’s asked licensee for the facility records which included children and staff files. Five children’s files were reviewed and 3 staff files were reviewed. LPA observed immunization records, emergency information, and signed Family Child Care Home Notification of Parents' Rights in children's files. The licensee’s immunization records for measles (MMR) were missing for 2 assistants. All employees have a declination letter on file for Flu

Licensee currently does not have any children enrolled that require IMS. If in the future any IMS is provided, Licensee acknowledges that a Plan for Providing IMS must be submitted to the Department.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417.

Continued on LIC 809C
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina BeckbyTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: FACHA, VARNA
FACILITY NUMBER: 393616871
VISIT DATE: 01/18/2023
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Licensee stated she does not provide care to infants. LPA's discussed the safe sleep regulations with Licensee and provided 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.

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 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. LPA also encouraged Licensee to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.

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.

In the areas that were evaluated, Technical Advisories were discussed with Licensee.

Continue on LIC 809C
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina BeckbyTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: FACHA, VARNA
FACILITY NUMBER: 393616871
VISIT DATE: 01/18/2023
NARRATIVE
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An Exit interview was conducted, and the report was reviewed with Licensee. LPA's posted a notice of site visit. Licensee understands the Notice must remain posted for 30 days and that a failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina BeckbyTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6