455408094-5-18-2022-13-CC-JSNW-CECRMU-20220512130919

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 455408094
Report Date: 05/12/2022
Date Signed: 05/18/2022 06:34:52 PM

Document Has Been Signed on 05/18/2022 06:34 PM - It Cannot Be Edited

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:	LACK, KIMBERLY FAMILY CHILD CARE HOME		FACILITY NUMBER:	455408094
ADMINISTRATOR:	LACK, KIMBERLY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 510-1928
CITY:	REDDING	STATE: CA	ZIP CODE:	96002
CAPACITY:	14	CENSUS: 0	DATE:	05/12/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Kimberly Bowyer		TIME COMPLETED:	01:30 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	A prelicensing inspection was conducted today at 1:15pm by Licensing Program Analyst (LPA), Snow. LPA met with applicant/licensee/facility representative Kimberly Lack. The applicant is requesting a license for a capacity of 14. The facility will operate Monday-Friday, 730am to 530pm. The residence is a 4 bedroom, 2 bath single, two story home. There are 2 adults currently living in the home. The home and yard were toured, and the facility sketch was verified. Half the house is off limits including the kitchen, bathroom & 3 bedrooms; entry is prevented by a locked door. *Enter the facility through the fence on the left of the home; The daycare is one bedroom and one bathroom and large hall laundry area. Poisons are locked in the garage. The home is equipped with a working smoke detector and fire extinguisher rated at least 2A10BC. The fireplace off limits. Children will use the backyard as the outdoor play area. The backyard is completely fenced. The applicant said there is no body of water, and none were observed. The applicant is aware not to add any body of water without prior approval. LPA reviewed with applicant/licensee/facility representative the LIC 311D, Forms/Records To Keep In Your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted. Applicant/Licensee/Facility representative was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. continued

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jaime Snow	TELEPHONE: (530)215-6132
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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: LACK, KIMBERLY FAMILY CHILD CARE HOME	FACILITY NUMBER: 455408094
	VISIT DATE: 05/12/2022

NARRATIVE

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A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA discussed the safe sleep regulations with applicant/licensee/facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant/licensee/facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
The physical plant is ready for licensure and all the documents have been submitted. This is a change of location and the licensee/applicant requests to be licensed on 5/19/22.
Exit interview conducted and report was reviewed with the applicant/licensee, Kimberly Lack.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jaime Snow	TELEPHONE: (530)215-6132
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC809 (FAS) - (06/04)

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