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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 475407997
Report Date: 10/28/2021
Date Signed: 11/01/2021 08:19:37 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:HARRIS, SARA FAMILY CHILD CARE HOMEFACILITY NUMBER:
475407997
ADMINISTRATOR:HARRIS, SARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(541) 913-7720
CITY:WEEDSTATE: CAZIP CODE:
96094
CAPACITY:14CENSUS: 0DATE:
10/28/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Sara HarrisTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) N. Cunningham conducted a prelicensing inspection in response to a change of location application received on 10/07/21. The licensee was previously licensed at facility number #475407451. The licensee is requesting a license for a capacity of 14 children. Services will be available Sunday – Saturday, 5:00 AM – 11:00 PM. The licensee understands that 24hr consecutive care is prohibited. Fire Clearance was received by the Department on 10/25/21. The residence is a five bedroom, two bathroom home. There is one adult living in the home. The licensee was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. The licensee is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance.

The floor and yard plans are verified. The children will have access to living room, playroom, dining room, and bathroom. The home appears to be clean and orderly at this time and will remain so during child care hours. The sharp knives, cleaning supplies, medicines, are inaccessible to children, located in the laundry area which is locked and out of reach of children. The applicant states no firearms and/or weapons are on the property and none were observed during today's inspection. Poisons will be locked with a key lock in the garage. The children in care will have access to age appropriate toys and equipment. The children will nap in the living room on nap mats. LPA discussed new Safe Sleep regulations, and the requirements for form LIC9227 and visual checks every 15 minutes to be logged on a sleep log. The home is equipped with a working smoke detector, carbon monoxide detector, fire extinguisher rated at least 2-A 10:BC. The living room has a monitor heater which is made inaccessible with a child gate.

The children will use the front yard as the outdoor play area which is completely fenced. The licensee plan on setting up a small trampoline and stated that it will be used according to manufacture guidelines. There is 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 the licensing agency.

Continue on LIC809-C
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: (530) 513-0993
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: HARRIS, SARA FAMILY CHILD CARE HOME
FACILITY NUMBER: 475407997
VISIT DATE: 10/28/2021
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The children will use the front yard as the outdoor play area which is completely fenced. The licensee plan on setting up a small trampoline and stated that it will be used according to manufacture guidelines. There is 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 the licensing agency. Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

Incidental Medical Services regulations were reviewed with the licensee. The licensee understands that if Incidental Medical Services are provided, an updated Plan of Operation shall be submitted and on file with the Department.

LPA consulted on COVID-19 guidelines and reporting requirements which consisted of social distancing, facial covering, conducting visual well-ness checks, temperature screening, hand washing for a minimum of 20 seconds, and reporting positive cases or exposures to public health and CCL.

Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. Proof of control of property or landlord notification is on file. Emergency drills must be conducted at least once every six months and the date documented. Children's records to be maintained were reviewed. The 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 licensee will maintain current pediatric CPR, First Aid, and child abuse mandated reporter training certification. The licensee 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 licensee understands that children may only be transported by adults with a criminal record clearance and are never to be left unattended in



Continue on LIC809-C
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: (530) 513-0993
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: HARRIS, SARA FAMILY CHILD CARE HOME
FACILITY NUMBER: 475407997
VISIT DATE: 10/28/2021
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a vehicle. Infants and children shall not be allowed to sleep in car carriers in the home. The licensee clearly understands 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 aged. Smoking is prohibited at all times in any area where child care is provided. The licensee understands 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/. The licensee understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice. Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

This facility meets licensing standards and is licensed as a Small Family Child Care Home as of 01/29/2020.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: (530) 513-0993
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3