393621390-12-5-2019-53-CC-SWIS-BJKPNU-20191205102830

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393621390
Report Date: 12/05/2019
Date Signed: 12/05/2019 10:28:37 AM

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:	STEPHEN, DAISY		FACILITY NUMBER:	393621390
ADMINISTRATOR:	STEPHEN, DAISY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 802-7171
CITY:	MOUNTAIN HOUSE	STATE: CA	ZIP CODE:	95391
CAPACITY:	14	CENSUS: 6	DATE:	12/05/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Daisy Stephen		TIME COMPLETED:	10:40 AM

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) Stacey Williams met with licensee, Daisy Stephen for an unannounced random annual inspection. There were (6) six children present during today’s inspection. Licensee’s assistant and husband were present in the home during the inspection. Criminal record clearances were verified for residents living in the home and licensee’s assistant. LPA toured areas of the home accessible to children in care. Off-limit areas include the entire upstairs, master bedroom, and the garage. The backyard is fenced. Licensee acknowledged that children may never enter these off-limit areas. Licensee acknowledges that children may never be left unsupervised in an unfenced area of the front yard. There are no bodies of water on the property. LPA observed fire drills are conducted and documented to meet regulation guidelines. LPA reviewed CPR/First Aid certification which expires September 2020. LPA reviewed child, licensee, and licensee’s assistant’s file. Immunization records were reviewed. Licensing postings were viewed on the wall near the childcare room. Hazardous items and cleaning supplies were inaccessible to children and kept in an off limit area. Medications are inaccessible to children. Fire extinguisher and smoke detector meet regulation. Carbon monoxide detector was operable. Incidental Medical Services (IMS) policy was discussed. 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. Report continues the following page, LIC 809C

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019

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: STEPHEN, DAISY	FACILITY NUMBER: 393621390
	VISIT DATE: 12/05/2019

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LPA discussed the Mandated Reporter Training with licensee. Mandated training is to be renewed every two years and available at: HTTP://WWW.MANDATEDREPORTERCA.COM .

There were no Title 22 deficiencies observed in the areas evaluated during today’s inspection.

This facility evaluation report was reviewed and discussed with the licensee. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. The implementation of AB 2370, lead exposure in Family Child Care Homes and proposed safe sleep regulations was discussed. A copy of this report will remain on file for a period of 3 years for public review upon request. A notice of site visit was provided and should remain posted for 30 days for parental review. Appeal rights were discussed and provided to licensee.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019

LIC809 (FAS) - (06/04)

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