573607438-11-22-2019-53-CC-CHUR-BJ6RFS-20191122115938

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 573607438
Report Date: 11/22/2019
Date Signed: 11/22/2019 11:59:46 AM

COMPREHENSIVE INSPECTION

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	GEE, DOROTHEA & CABALTERA, ELIZA		FACILITY NUMBER:	573607438
ADMINISTRATOR:	GEE,DOROTHEA&CABALTERA,ELI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 662-5667
CITY:	WOODLAND	STATE: CA	ZIP CODE:	95695
CAPACITY:	14	CENSUS: 3	DATE:	11/22/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Licensees, Dorothea Gee and Eliza Cabaltera		TIME COMPLETED:	12:10 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	Licensing Program Analysts (LPAs) Chayntel Hunter and Christopher Jackson met with Licensees Dorothea Gee and Eliza Cabaltera and their assistant for the purpose of an unannounced annual random inspection. All individuals subject to criminal background review have obtained a criminal record clearance. Upon arrival one child was present. During the inspection two additional children arrived, making the census a total of 3 children. Licensees' operating hours are Monday through Sunday from 4:45 AM to 12:30 AM. A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include: master bedroom, son's bedroom, office, laundry room and the garage. LPA observed the required postings, a working phone, 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors. LPAs observed weapons stored according to Title 22 regulations. There are no bodies of water on the premises. LPAs observed a fireplace that was blocked by a couch. Outdoor play space is fenced. The play equipment appears to be in good repair. LPAs observed a locked shed on the left side of the backyard. LPAs observed the additional shed on the right side of the backyard. There were no hazardous items accessible to children in care inside the shed on the right side. The back side yards are blocked by a gate. During today's inspection LPAs reviewed 11 children's files. Emergency information and required immunization records were on file. LPAs observed a current roster. Licensees' immunization records for measles (MMR), pertussis (Tdap), and the flu are available in the facility file. Current in-person EMSA pediatric CPR and First Aid certification was verified and expires 03/21 and Child Care Provider Mandated Reporter was discussed. The training is currently only provided in English and is available online at mandatedreporterca.com. Report continues on 809-C.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019

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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: GEE, DOROTHEA & CABALTERA, ELIZA	FACILITY NUMBER: 573607438
	VISIT DATE: 11/22/2019

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

This provider is not currently providing IMS services to children in care. Incidental Medical Services (IMS) policy was discussed.

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 (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.

LPAs verified the annual fees are current.

LPAs provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so Licensees can request to be added to the distribution list to receive Quarterly Updates. LPAs provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochures.

This facility evaluation report was reviewed and discussed with Licensees. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. Licensees were encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. Licensee's signature on this form acknowledges receipt of this form.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2