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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393617140
Report Date: 03/10/2020
Date Signed: 03/10/2020 02:34:15 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:DOOLEY, IRENEFACILITY NUMBER:
393617140
ADMINISTRATOR:DOOLEY, IRENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 401-7196
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:14CENSUS: 5DATE:
03/10/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Irene DooleyTIME COMPLETED:
02:40 PM
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LPA Baney met with licensee for the purpose of an annual inspection. All individuals subject to criminal background review have obtained a criminal record clearance. A health and safety evaluation was conducted in all areas accessible to children. Adequate supervision was observed. Off-limits areas include: upstairs and garage. LPA observed a working phone, 2A10BC fire extinguisher, first aid kit and functioning smoke and carbon monoxide detectors. Per Licensee, there are no weapons in the home. Toxic and hazardous items are inaccessible to children. Safe toys and comfortable accommodations were observed. The fireplace and stairs in the home are appropriately barricaded to prevent access by children. Outdoor play space is fenced and supervised when is use.

Licensee does not provide Incidental Medical Services (IMS). Medication was appropriately stored an inaccessible to children. For IMS information, licensee was advised to see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.

Staff and children's records were reviewed. Required postings, a disaster drill log and proof of mandated reporter training and immunization's were observed. Current pediatric CPR and first aid certification was verified. This facility evaluation report was reviewed and discussed with the licensee. A notice of site visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CCLD.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 3 years for public review upon request.
In the areas that were evaluated, no deficiencies were cited.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Charlotte BaneyTELEPHONE: (916) 216-7791
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020
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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