515407637-11-1-2019-13-CC-MMAZ-BHHPF3-20191101111603

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 515407637
Report Date: 11/01/2019
Date Signed: 11/01/2019 11:16:10 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:	RISK, DONNA FAMILY CHILD CARE HOME		FACILITY NUMBER:	515407637
ADMINISTRATOR:	RISK, DONNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 713-0255
CITY:	YUBA CITY	STATE: CA	ZIP CODE:	95991
CAPACITY:	14	CENSUS: 0	DATE:	11/01/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Donna Risk		TIME COMPLETED:	11:25 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	A pre-licensing inspection was conducted today by LPA Mikah Martinez. The licensee is requesting a license for a capacity of 12-14. Services will be provided Mon-Fri 6am-5:30pm. The residence is a three bedroom/ two bath home. There are two adults living in the home. The applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. All minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday and obtain a TB clearance. The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance. Children will have access to the living room, kitchen, dinning room, a open play room next to the living room and one restroom. The hallway leading to the bedrooms is off limits and will have a gate prohibiting entry. Poisons are stored in the garage and are inaccessible to children. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. There are no firearms stored in the home and none were observed. There is one fire place in the home that is nto operable and does have a lock to prevent access. The children in care will have access to age appropriate toys and equipment. The home is equipped with a working smoke detector and carbon monoxide detector. A fire extinguisher rated at least 2A10BC is needed in the home. The children will use the backyard as the outside play area and it is fully fenced. The applicant may intend to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan for Providing IMS must be submitted to the Department. 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.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Mikah Martinez	TELEPHONE: (530) 895-4014
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019

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

FACILITY NAME: RISK, DONNA FAMILY CHILD CARE HOME	FACILITY NUMBER: 515407637
	VISIT DATE: 11/01/2019

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 provider does maintain liability insurance and will provide the department with a copy of the insurance. Proof of home ownership is on file. Parent's rights poster is posted. 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 applicant will remain current on Pediatric CPR and First Aid. The applicant 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 applicant understands that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. The applicant 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 those areas where childcare is provided.

The applicant 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/. Megan's Law web site was provided (http://www.meganslaw.ca.gov). The licensee understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice. This report was reviewed and discussed with the applicant. Guide to Safe Sleeping Practices pamphlet was provided and discussed.

The following needs to be corrected before issuance of the license:
1. Individual 3 needs completion of CAIC
2. Fire clearance is required as we have not received the original through the mail.
3. Fire extinguisher rated at least a 2A10BC is needed
4. Liability Insurance Bond (copy)
5. 1 hour of Nutrition must be completed.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Mikah Martinez	TELEPHONE: (530) 895-4014
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2