401712106-9-9-2021-17-CC-GRES-C6PS7N-20210909133750

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 401712106
Report Date: 09/09/2021
Date Signed: 09/09/2021 01:38:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	BAKER FCC AKA STACEY'S DAYCARE		FACILITY NUMBER:	401712106
ADMINISTRATOR:	STACEY JOLANE BAKER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 434-5589
CITY:	TEMPLETON	STATE: CA	ZIP CODE:	93465
CAPACITY:	14	CENSUS: 9	DATE:	09/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Stacey Baker and Amanda Geiger		TIME COMPLETED:	01:36 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	On 9/9/2021 Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced annual required inspection. LPA asked Licensee of pre- screening questions related to COVID-19, Licensee's responses suggest no COVID-19 exposure on site. LPA met with Licensee Stacey Baker and assistant Amanda Geiger and discussed the purpose of the inspection. There were 9 children present. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. LPA toured the interior and exterior of the day care. LPA observed required licensing forms are posted in the Family Child Care Home (FCCH). LPA observed smoke and carbon monoxide detectors in the FCCH,. The regulation fire extinguisher was serviced on May 5, 2021. Home conducts and documents fire and disaster drill every month. The most recent fire/disaster drill was conducted last 9/7/2021. The bathroom was inspected and observed to be clean and free of toxin. LPA observed the day care is clean and free of hazardous items. The backyard is enclosed by wooden fence. LPA observed age appropriate toys and play equipment. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the home.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: BAKER FCC AKA STACEY'S DAYCARE	FACILITY NUMBER: 401712106
	VISIT DATE: 09/09/2021

NARRATIVE

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LPA Reyes reviewed facility file and found complete, Pediatric CPR and First Aid expires on 9/19/2021. Licensee and assistant are registered to renew Pediatric CPR and First Aid on 9/14/2021. AB 1207 Mandated Reporter Training was taken on 7/9/2020. Licensee was reminded that Mandated Reporter Training should be renewed every two years. Children's files were reviewed and contain Emergency Identification Card.

LPA discussed Safe Sleep Regulations with Licensee. Providers must check on sleeping infants (0 to 24 months) every 15 minutes and document their condition to check for signs of distress, which includes, but is not limited to labored breathing, flushed skin color, increase in body temperature, and restlessness. Each infant, up to 12 months of age, must have an Individual Infant Sleeping Plan (LIC 9227) on file, which will document the infant's sleeping habits, usual sleep environment, and the infant's rolling abilities.

The Licensee is not providing Incidental Medical Services (IMS). Policy was discussed. 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

Exit interview conducted with Licensee and assistant. Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: https://www.cdss.ca.gov/inforesources/child-care-licensing

In the areas evaluated, no deficiencies observed.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

LIC809 (FAS) - (06/04)

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