475406507-6-28-2021-13-CC-JSNW-C4BU9A-20210625152249

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 475406507
Report Date: 06/25/2021
Date Signed: 06/28/2021 08:59:21 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:	ANDERSON, KAYLA FAMILY CHILD CARE HOME		FACILITY NUMBER:	475406507
ADMINISTRATOR:	ANDERSON, KAYLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 340-0895
CITY:	YREKA	STATE: CA	ZIP CODE:	96097
CAPACITY:	14	CENSUS: 11	DATE:	06/25/2021
TYPE OF VISIT:	Required - 1 Year	ANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Kayla Anderson		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	An annual/random inspection was made to the facility by Licensing Program Analyst (LPA) Snow who met with the licensee, Kayla Anderson. A review of staff records on 6/18/21 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 and two minors living in the home. During today’s inspection the home and grounds were toured. The licensee and an assistant were supervising eleven children and operating within the licensed capacity. No children were observed left in any parked vehicle. The facility’s operating hours are 7:30am to 5:30pm, Mon–Fri. The floor plan submitted by the licensee was reviewed and verified. The off limits areas of the home are the master and adjacent bedroom (hall gate) and door to the garage (doorknob cover/lock). The home was clean and orderly. There was a working telephone in the home. The licensee has current pediatric CPR and First Aid certification, which expire on 10/19/21. The licensee and assistants have completed Mandated Reporter Training (expire 2022). Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were stored out of the reach of children. Poisons were locked in a cabinet in the garage.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jaime Snow	TELEPHONE: (530)215-6132
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2021

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

FACILITY NAME: ANDERSON, KAYLA FAMILY CHILD CARE HOME	FACILITY NUMBER: 475406507
	VISIT DATE: 06/25/2021

NARRATIVE

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There is a trampoline that is made off limits with a netting; the licensee is aware they need to follow the manufacturers guidelines when children play on it.

There are is seasonal water and a waiver is in place: the terms of the waiver were being followed at the time of the visit. The Licensee said the ammunition is seperately locked and the weapons are locked in a safe. The items which could pose a danger to children (such as disinfectants, cleaning solutions and medications) are inaccessible to children. Poisons are locked in the garage. Furniture and equipment are in good condition and free of hazards. The outdoor activity space was cushioned with bark and free of hazards. Toilets and sinks are in sanitary condition and operating properly. The facility floors were clean and safe. The kitchen/food preparation The facility was free of flies, insects and rodents. The facility has a working carbon monoxide detector. The staff files contain the proof of immunization's and Mandated Reporter training. Four children's files were reviewed and found to contain emergency information, immunization's and safe sleep documentation.

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.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jaime Snow	TELEPHONE: (530)215-6132
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2021

LIC809 (FAS) - (06/04)

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