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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622804
Report Date: 02/04/2020
Date Signed: 02/04/2020 03:20:27 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:STOREY, MONICAFACILITY NUMBER:
393622804
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
02/04/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Monica StoreyTIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Singh met with licensee, Monica Storey, for an annual random inspection. The purpose of the inspection was explained. Licensee lives in a single story home. Present, there are four children (including two foster children) in care. All adults living or working in the home have criminal background check on file. Licensee is operating within the capacity of this date.

LPA inspected the day care areas with the licensee. There are no bodies of water in the house. Per licensee, there are no pets and no firearms or weapons in the house. Fireplace is properly barricaded. All the cleaning supplies, poisons and other chemicals are stored inaccessible to the children. The house is in good repair and free of hazards with proper temperature and ventilation. There are multiple carbon monoxide detectors and smoke detectors in the house. LPA observed fully charged fire extinguisher and working telephone available in the house. There is a variety of age appropriate toys in the house.

LPA review the facility records. LPA observed facility has all of the required documents posted and visible for the public. LPA reviewed the identification and emergency information form for every child for proper names and numbers filled. Licensee has record of immunization of each child in enrolled. Licensee’s immunization records were previously checked. Licensee has well maintained roster on file. Licensee has log in place for fire and emergency drills. Per log, last drill was conducted on October 11, 2019. Licensee is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Licensee has completed the training and has certificate on file.

LPA discussed the safe sleep regulation concepts and effects of lead exposure. LPA provided the handouts for more information. LPA encourage the licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.
No deficiencies are cited today. The copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2020
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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