485407546-6-23-2021-13-CC-KMAS-C49NUZ-20210623104710

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 485407546
Report Date: 06/23/2021
Date Signed: 06/23/2021 10:47:16 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:	NAEBKHEL, SURYA FAMILY CHILD CARE HOME		FACILITY NUMBER:	485407546
ADMINISTRATOR:	NAEBKHEL, SURYA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 600-8145
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95687
CAPACITY:	14	CENSUS:	DATE:	06/23/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Licensee, Surya Naebkhel		TIME COMPLETED:	10:50 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	On 6/23/2021 at 9:30am, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Kirk Marks. A review of staff records on 6/21/2021 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 four adults living in the home. At 9:40am the home was toured inside at outside. The licensee and assistant were supervising nine children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 7:00am to 5:00pm, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are upstairs, which includes all bedrooms and two bathrooms, kitchen and garage, and were made inaccessible by safety gates and door locks. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection. Poisons are not stored at the home. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The home is clean, orderly and comfortable. The stairs are barricaded with a locking safety gate. There is a working telephone in the home.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Kirk Marks	TELEPHONE: (530) 895-5045
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

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: NAEBKHEL, SURYA FAMILY CHILD CARE HOME	FACILITY NUMBER: 485407546
	VISIT DATE: 06/23/2021

NARRATIVE

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There are play yards available for sleeping infants. The play yard mattresses are firm, and the cribs are free of loose items. Infant bedding is cleaned weekly, and soiled bedding is stored inaccessible to infants. No infants were observed to be swaddled while sleeping. The licensee conducts physical checks on sleeping infants every 15 minutes, and checks are documented on child's activity schedule. The infants sleep in play room, and the door remains open at all times. Infants under 12 months are placed on their backs for sleeping.

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.

Records were reviewed at 10:05am. There is a current roster of children in care. Fire drills are conducted at least every six months and documented. The licensee and staff have proof of immunizations on file.

Children’s records were reviewed at 10:10am. Infants under 12 months have an Individual Infant Sleeping Plan on file.

This report was reviewed 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.

There were no Title 22 deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Kirk Marks	TELEPHONE: (530) 895-5045
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

LIC809 (FAS) - (06/04)

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