455407625-11-19-2019-13-CC-CWIT-BJ3PJH-20191119102136

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 455407625
Report Date: 11/19/2019
Date Signed: 11/19/2019 10:21:47 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:	LAKEY, STACY FAMILY CHILD CARE HOME		FACILITY NUMBER:	455407625
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS:	DATE:	11/19/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	07:45 AM
MET WITH:	Stacy Lakey		TIME COMPLETED:	09:15 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	A pre-licensing inspection was conducted on 11/19/19 by Licensing Program Analyst (LPA) Wisehart. The applicant has requested a license for a capacity of eight children. The facilities operating hours will be 6:30 am thru 6 pm Monday - Friday. The residence is a three bedroom/two bath home. Applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with California Department of Social Services Community Care Licensing Division (CCLD). All minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday and obtain a TB clearance. The applicant is aware of an immediate monetary current rate per day of civil penalty for adults working or residing in the home without a criminal record clearance. Two bedrooms and one bathroom are off limits to the children in care and has been made inaccessible by means of doorknob locks./covers. The home appeared to be clean and orderly at this time and will remain so during child care hours. There was a working telephone in the home. The sharp knives, cleaning supplies, and medicines were stored out of the reach of children. The applicant stated poisons are to be locked inaccessible in the garage. The applicant reported weapons and ammunition are locked and stored separately . The children in care will have access to age appropriate toys and equipment. The applicant understands that no prohibited children's seating and/or playing items such as "Infant Bouncers", "Baby Walkers", "Johnny Jumpers" and "Saucer Chairs" are to be used while children are in care. Any such items must be stored out of sight inaccessible to children in care. The home was equipped with a working smoke detector, carbon monoxide detector, and charged fire extinguisher rated at least 2A:10B:C. The facility has a pellet stove which has the appropriate fire fencing. At this time the applicant is using the backyard as a children's play area and it is fully fenced however, the area is not to be used until the two large dead tree branches which appear to be hanging/broken are safely removed. Continued on next page...

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019

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: LAKEY, STACY FAMILY CHILD CARE HOME	FACILITY NUMBER: 455407625
	VISIT DATE: 11/19/2019

NARRATIVE

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There was no trampoline on the premises. There was no pool, spa, pond, fountain, nor any other source of water accessible to the children, and none is to be added without prior notification and approval of CCLD.

Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. Parents' rights were posted. Emergency drills must be conducted at least once every six months and the date must be documented. The children's roster is to remain current at all times. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days. The applicant will maintain current Pediatric CPR and First Aid which expires on 10/13/21. The applicant shall be present in the home and shall ensure that children in care are supervised by a fingerprinted adult with current Pediatric CPR and First Aid certification. The applicant understood that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. The applicant understood the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school-age. Smoking is prohibited in the home at all times and in outdoor areas where children are present.
The applicant has plans to treat for Incidental Medical Services (IMS); and will be developing a written IMS policy which will be submitted to CCL by 12/3/19. 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.
The applicant understood the responsibility to read and have knowledge of the laws and regulations for operation of a family child care home. Forms and regulations must be obtained from the website (http://ccld.ca.gov/). Megan's Law web site was provided (http://www.meganslaw.ca.gov). The licensee understood that any authorized employee of the Department may enter and inspect the facility with or without advance notice. This report, as well as ***safe sleep guidelines (***a handout was provided), was reviewed and discussed with the applicant.
Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019

LIC809 (FAS) - (06/04)

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