393622066-1-2-2020-53-CC-ASRN-BKFS4M-20200102123300

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393622066
Report Date: 01/02/2020
Date Signed: 01/02/2020 12:33:15 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:	HILL, SUSAN		FACILITY NUMBER:	393622066
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	01/02/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Susan Hill		TIME COMPLETED:	12:35 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) Aruna Sridharan met with licensee Susan Hill for an unannounced annual inspection. The facility operates Monday through Saturday 24 hours. This is a two story home with four bedrooms and three bathrooms. LPA toured all areas of the home that are accessible to the children and a current roster of children. There were no children in care at the time of inspection. LPA confirmed that all adult residents residing have criminal record clearances. LPA advised licensee if anyone over the age of 18 years old moves into the home they must have a criminal record clearance as well. LPA observed posting of the license, Parent's Rights and the current disaster plan. Off-limit areas include entire upstairs, laundry, garage and shed. Licensee acknowledged that children may never enter these off-limit areas. The backyard is fenced and licensee acknowledges that children may never be left unsupervised in an unfenced area of the yard. There is a spa which has barricade and gate self latches. The licensee has a shed in the backyard which is locked at all times. Licensee stated there are weapons in the home. LPA observed current CPR and First Aid certificate that expires on 12/2021. LPA observed that poisons are locked and that fire extinguisher, smoke detector and carbon monoxide detector meets regulation. Fireplace is screened, cleaning materials, hazardous items and medications are all inaccessible to children. Licensee provides transporation to and from elementary school. Licensee was advised on carseat safety. LPA provided the lead exposure handout and advised to give out to the clients. Report continues on 809C....

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2020

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: HILL, SUSAN	FACILITY NUMBER: 393622066
	VISIT DATE: 01/02/2020

NARRATIVE

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LPA observed Fire Drill Log and the last fire drill was conducted on 11/19 and current roster. There is a working telephone, toys appear to be in a safe condition and the home appears to be clean and orderly.

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 the licensee that it is her responsibility to stay up-to-date and informed in regards to new regulations.

LPA discussed the new Immunization Regulations SB 792; licensee has proof of vaccinations. LPA advised the licensee on the new regulation AB 1207- California Child Care Worker: Mandated Reporter Training. The licensee must complete the training every two years starting January 1, 2018 and retain proof of completion in the facility file. The training can be found at: mandatedreporterca.com.

LPA also discussed the Incidental Medical Services (IMS) policies with the licensee. The facility is not currently providing IMS. If the licensee plans to provide IMS in the future she can refer to: 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: www.ada.gov/childqanda.htm

LPA also discussed Unusual Incident Reports (UIRs) and reporting requirements. LPA informed the licensee that if any unusual incidents occur she must contact the Department within 24 hours and an UIR must be submitted with 7 day, describing the specifics to the incident.
Report continues on 809C.......

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2020

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: HILL, SUSAN	FACILITY NUMBER: 393622066
	VISIT DATE: 01/02/2020

NARRATIVE

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LPA advised the licensee on Safe Sleep Practices and SIDS; the licensee stated they are understood and practiced. She stated she uses porta cribs for sleeping infants and understand infants cannot sleep in car seats, swings or other items not intended for sleeping.

No Title 22 Deficiencies were observed in the areas that were evaluated during today's inspection. LPA read this report to the licensee; stated that they understand today’s inspection. Notice of Site Visit posted and the licensee understands it must remain posted for 30 days. Appeal rights were provided to Licensee.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2020

LIC809 (FAS) - (06/04)

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