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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621534
Report Date: 05/03/2019
Date Signed: 05/03/2019 02:21:30 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:WHITE, CHELSEAFACILITY NUMBER:
393621534
ADMINISTRATOR:WHITE, CHELSEAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 679-8328
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY:14CENSUS: 7DATE:
05/03/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Chelsea WhiteTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Christopher Jackson met with licensee Chelsea White for an unannounced random annual inspection and toured areas of the home accessible to children in care. Off-limit areas are: Master Bedroom, Bedroom #1, Garage, Carport, Utility rooms, and shed. Licensee acknowledged that children may never enter these off-limit areas. The census included seven children in care. Also present was licensee’s assistant. Licensee stated there are no new residents in the home since licensure. All Adult residents have criminal record clearances. Licensee stated the program operates Monday thru Friday 6:00 AM to 6:00 PM.

LPA toured the facility inside and outside. The facility is a single story home with three bedrooms an attached garage, a carport, large fenced back yard, and extra fenced playground area. There are 2 outside play areas: the back yard, which is fully fenced and contains an empty pool, and a fenced play space with climbing equipment and a locked storage shed. The pool is surrounded by a cyclone fence at least 5 ft.high, which is covered by mesh netting, LPA observed the gate to swing away from the pool, self-close and self-latch.

Fire extinguishers, smoke detectors and carbon monoxide detectors meet regulations. Cleaning products are stored in a latched kitchen cabinet under the sink. Sharp knives are stored in a container in a cupboard above the counter. Toys appear to be safe. Licensee stated that there are no weapons in the home. Adult residents and assistants have criminal record clearance. LPA observed 2 fireplaces and both are screened. LPA observed current Pediatric first aid and CPR which expires on 06/01/2020.



-- Report continues on subsequent page 809-C
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher JacksonTELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019
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: WHITE, CHELSEA
FACILITY NUMBER: 393621534
VISIT DATE: 05/03/2019
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Incidental Medical Services (IMS) policy was discussed. 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.

LPA discussed recent changes in licensing requirements, including SB 277 (no longer accepting religious beliefs for immunization's) and SB 792 pertaining to immunization requirements for children and staff - Licensee provided proof of immunization's.

LPA discussed the new Mandated Reporter Training with licensee. Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. In addition, existing licensees must meet requirements by March 30, 2018. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English. LPA observed completion certificate during today's inspection.

LPA checked facilities fees and confirmed that it is up to date.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the licensee and provided copies. An exist interview was conducted. LPA observed the Notice of Site Visit posted and the licensee understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher JacksonTELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019
LIC809 (FAS) - (06/04)
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