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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622066
Report Date: 06/15/2020
Date Signed: 06/16/2020 01:44:09 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, SUSANFACILITY NUMBER:
393622066
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
06/15/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Susan HillTIME COMPLETED:
10:45 AM
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Due to COVID-19 pandemic, Licensing Program Analyst (LPA) Christopher Jackson is conducting a tele-video inspection via FaceTime with the Applicant Susan Hill. The purpose of today's inspection is to conduct a change of capacity inspection. Licensee has applied for a large family home day-care. All adult individuals subject to criminal background review have obtained a criminal record clearance and are cleared through the department.

LPA conducted a virtual tour of the home with the Licensee. The downstairs area of the two-story home consists of a kitchen, family room,living room, laundry room, restroom and bedroom. Off-limit area include: entire upstairs, laundry room, and garage. Licensee acknowledged that children may never enter these off-limit areas. Licensee has requested a capacity increase of 14 children. Fire clearance has been approved by the Stockton Fire Department on 06/08/2020. Licensee stated there are no new residents in the home since licensure. All Adult residents have criminal record clearances. During today's inspection LPA discussed large family child care home capacity limitations with licensee.

LPA observed cleaning supplies properly stored out of reach of children. LPA observed medications out of reach of children. Fireplace is properly barricaded. Licensee stated there are no weapons in the home. LPA observed fire extinguisher, smoke detector, and carbon monoxide in the home. The backyard is fenced and has an above ground spa. LPA observed the spa to be surrounded by a see through fencing that meets regulation and there are no windows or doors that provide direct access to the spa area. Licensee understands that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes.

LPA observed a current CPR/First Aid certificate Exp 12/2020. LPA advised licensee to visit the licensing website at http://www.ccld.ca.gov for current forms, laws, regulations and legislation.

Effective today's date, 06/15/2020, LPA will approve the capacity increase to serve up to either 14 children, two (2) of which must be at least 6 years of age and no more than three (3) may be infants; or 12 children, four (4) of which may be infants. Infants are children under the age of 2.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher JacksonTELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2020
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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