483003697-8-27-2019-01-CC-KOCL-BFFPYP-20190827114418

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483003697
Report Date: 08/27/2019
Date Signed: 08/27/2019 11:44:43 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME:	BELLARD-HODGE, PRISCILLA FAMILY CHILD CARE HOME		FACILITY NUMBER:	483003697
ADMINISTRATOR:	BELLARD-HODGE, PRISCILLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 330-6565
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY:	14	CENSUS: 4	DATE:	08/27/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Priscilla Belard-Hodge		TIME COMPLETED:	11:59 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/Required inspection was made to the facility by Licensing Program Analyst (LPA), Kevin O'Connell. A review of staff records on 08/27/19 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 is currently one adult living in the home. During today’s inspection the home and grounds were toured. The licensee and her assistant were supervising one infant and three preschool children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are 6:30am 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 living room, family room, kitchen and four bedrooms, and were made inaccessible by plastic door knob covers and a child safety gate. The children have access to the converted garage, one downstairs bathroom and the backyard. The home was clean and orderly, and was at a comfortable indoor temperature. There is a working telephone in the home. The licensee has current pediatric CPR and First Aid certifications which expire on 02/2021. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were stored out of the reach of children.The Licensee states that there are no poisons but can lock them in the outdoor shed. The hall is barricaded with a child safety gate. The fireplace has glass doors. 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 4/19. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: BELLARD-HODGE, PRISCILLA FAMILY CHILD CARE HOME	FACILITY NUMBER: 483003697
	VISIT DATE: 08/27/2019

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
26
27
28
29
30
31
32

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.
This facility provides Incidental Medical Services – IMS (inhalers). LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) 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, available at: http://www.ada.gov/childqanda.htm

This report, as well as the AAP Guide to Safe Sleep, Safe Sleep in Childcare brochure, What does a Safe Sleep Environment Look Like brochure & Safe Sleep Concepts handout, were reviewed and discussed with the licensee. The Effects of Lead Exposure brochure has been reviewed with 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.

Failure to keep this notice posted for 30 days may result in a civil penalty of $100.
No deficiencies were cited today.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2