455407028-1-21-2020-13-CC-CWIT-BL2QEJ-20200121110621

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 455407028
Report Date: 01/21/2020
Date Signed: 01/21/2020 11:06:32 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	CLINE, OLGA FAMILY CHILD CARE HOME		FACILITY NUMBER:	455407028
ADMINISTRATOR:	CLINE, OLGA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 362-3862
CITY:	COTTONWOOD	STATE: CA	ZIP CODE:	96022
CAPACITY:	14	CENSUS: 2	DATE:	01/21/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Olga Cline		TIME COMPLETED:	09:00 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	An annual inspection was made to the facility by Licensing Program Analyst (LPA), Wisehart. A review of staff records on 1/21/2020 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently two adults living in the home. During today’s inspection the home and grounds were toured. The licensee was supervising two children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 6:30 am to 6:00 pm, Mon–Fri. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are all areas of the home except day-care room and side rooms connected, and were made inaccessible by exterior gate leading to the front of the home. The home is clean, orderly and comfortable. There is a working telephone in the home. The licensee has current pediatric CPR and First Aid certification, which expire on 7/19/2020. The LPA reviewed 2 out of 2 children records at 8:44 am and observed the immunization records; emergency and consent forms on file. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. Poisons are locked in other inaccessible areas of the house. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee has a current roster of children in care. The licensee has conducted an emergency drill within the past six months, last drill was conducted on 12/11/19.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: CLINE, OLGA FAMILY CHILD CARE HOME	FACILITY NUMBER: 455407028
	VISIT DATE: 01/21/2020

NARRATIVE

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The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection. The children use the backyard as the outdoor play area and it is fully fenced. There were no pools or bodies of water observed in the yard. There is a seasonal creek behind the home, therefore licensee has an amended waiver on file dated 1/22/2018 for mesh fencing that meets Title 22 regulations, and door and window locks, and the terms of the waivers are being met. The licensee is providing Incidental Medical Services (IMS) to children in care. The Incidental Medical Services (IMS) policy was discussed with the licensee. 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 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, www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices brochure, were reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection in relation to the annual visit.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

LIC809 (FAS) - (06/04)

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