493001553-7-9-2019-01-CC-JVEO-BDWSHX-20190709135415

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493001553
Report Date: 07/09/2019
Date Signed: 07/09/2019 01:54:22 PM

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:	DAMOS-DEURLOO, ANGELA FAMILY CHILD CARE HOME		FACILITY NUMBER:	493001553
ADMINISTRATOR:	DAMOS-DEURLOO, ANGELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 481-6898
CITY:	GUERNEVILLE	STATE: CA	ZIP CODE:	95446
CAPACITY:	12	CENSUS: 11	DATE:	07/09/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Angela Damos-Duerloo		TIME COMPLETED:	02:00 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 inspection was made to the facility by Licensing Program Analyst (LPA), J. Velasco. A review of staff records 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 living in the home.During today’s inspection the home and grounds were toured. Licensee Angela Damos-Deurloo (L1) and two assistants (S1 and S2) were supervising eleven 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 7:30 a.m. - 5:30 p.m., Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The children have access to the kitchen/dining area, living room, hall bathroom, one bedroom, and fully fenced side yard. The off-limits areas of the home are the upstairs, garage and backyard, outfields, barns, sheds, other homes on the property, and pool area, which were made inaccessible by locked gates and door locks. The home was observed to be clean and orderly and was at a comfortable indoor temperature. There were safe toys and equipment available for children. The licensee stated there is a working telephone in the home. There is a wood stove in the living room, made inaccessible by a secured screen made of non-heat-conducting material. L1, S1, and S2 pediatric CPR and First Aid certifications were reviewed and expire in 02/2020. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be stored out of the reach of children in the locked garage and locked kitchen cupboards. L1 stated there are poisons rendered inaccessible in the key locked shed in an off-limits area of the property. LPA observed a working smoke detector, carbon monoxide detector, and fire extinguisher, rated at least 2A10BC, in the home. The roster of children in care was reviewed and was current. Continued on LIC 809-C

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2019

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,
, CA

FACILITY NAME: DAMOS-DEURLOO, ANGELA FAMILY CHILD CARE HOME	FACILITY NUMBER: 493001553
	VISIT DATE: 07/09/2019

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Continued from LIC 809.
The licensee has conducted an emergency drill within the past six months. The last emergency drill was documented in 06/2019. L1 stated there are guns on the premises, stored and inaccessible in a locked gun safe in the inaccessible, key locked office of the home. The ammunition is stored separately from the weapons. The children use the side yard as the play area, and the property is fully fenced. L1 stated there is an above ground pool on the property, and L1 has a waiver for the fencing. The pool is in an inaccessible, fenced and gated backyard, which the children do not have access to. Seven children's records were reviewed at 11:00 a.m., and current immunizations and Notification of Parent’s Rights forms were on file. Facility and personnel files were reviewed at 12:00 p.m. and contained necessary records.

The licensee is not currently providing Incidental Medical Services (IMS) to children in care. The Incidental Medical Services (IMS) policy was discussed with the licensee. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

The following information regarding ADA was provided: US Department of Justice 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, www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were 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: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2019

LIC809 (FAS) - (06/04)

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