394500294-9-24-2020-53-CC-ASRN-BTS7KD-20200924214346

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500294
Report Date: 09/14/2020
Date Signed: 09/24/2020 09:44:06 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:	PETTIS HOUSTON, PAMELA		FACILITY NUMBER:	394500294
ADMINISTRATOR:	PETTIS HOUSTON, PAMELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 423-2681
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95218
CAPACITY:	14	CENSUS: 0	DATE:	09/14/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Pamela Pettis Houston		TIME COMPLETED:	10:30 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) Aruna Sridharan conducted a tele-inspection due to COVID-19 State of Emergency for the purpose of change of location. The tele-inspection was conducted on Google Duo. Licensee Pamela Pettis Houston applied for a change of location for a large family child care home. Previously, licensee was licensed at different location with license number 393621810 at 4263 Antique Place, Stockton CA 95219. The family child care home facility is two story single family home with five bedrooms and three bathrooms. Licensees lives with three other family members. Licensee and staff have criminal background clearances. The daycare hours of operation are 24 hours 6 days a week with Sunday off. Off limit areas: Entire upstairs, downstair bedroom and shed in the backyard. All off limits areas must be made inaccessible to children. Isolation of an ill child will be in living room. Licensee was notified that prior to use of any off limits area, the department must be notified. Licensee provides transportation services for children in care. LPA advised on safety car seat laws and requirement of CPR and Mandated Reporter for staff driving. LPA Sridharan tele-inspected the home with the applicant for health and safety hazards. The house has proper temperature and ventilation as there is air-conditioning unit in the garage where childcare will be provided. All the toxic or dangerous materials are inaccessible to children with child safety cabinet sliding locks on under the sink cabinet and bathroom cabinet. The house has a working telephone, fully charged wall mounted fire extinguisher, smoke detector and carbon monoxide detector that meet regulations. There is first aid kit available. There is a variety of age appropriate toys available. As per the licensee, there are no firearms or weapons in the home. There is no fireplace in the facility. LPA discussed licensing regulations and capacity requirements. Licensing forms and posting requirements were reviewed with the licensee. LPA also advised to licensee to get fingerprinting done immediately for any child turing 18 years of age. 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: 09/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

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: PETTIS HOUSTON, PAMELA	FACILITY NUMBER: 394500294
	VISIT DATE: 09/14/2020

NARRATIVE

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During the inspection, LPA received copies of Deed, CPR/First Aid Card that expires 02/22 and Mandated Reporter Certification expires 02/21. LPA observed the record of licensee’s immunization on file. During the inspection, LPA received updated Earthquake Disaster Plan and Current Children's Roster. Licensee has not completed the Lead component course although licensee showed proof of registration for the Lead Poisoning Prevention course which is on October 1st 2020. Licensee has the required postings in a conspicuous place.
LPA informed the licensee that Fire Drills need to completed every six months.
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 days, describing the specifics to the incident.
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 the inspection authority of the Department by authorized agent to enter and inspect the family child care home providing care, supervision and services at any time, with or without advance notice to secure compliance with the regulations in accordance with Section 102396.
LPA discussed that prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changes.
The applicant is encouraged to frequently visit website at http://www.ccld.ca.gov for licensing regulations and new updates. Applicant can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.
LPA did not observe any violation of regulations. As of 09/14/2020, the licensee is granted Provisional license for Large Family Child Care Home for this location. 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: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

LIC809 (FAS) - (06/04)

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