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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573615813
Report Date: 06/04/2019
Date Signed: 06/04/2019 02:11:43 PM

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:FULLER, AMYFACILITY NUMBER:
573615813
ADMINISTRATOR:FULLER, AMYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 376-0839
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY:14CENSUS: DATE:
06/04/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Amy Fuller TIME COMPLETED:
02:20 PM
NARRATIVE
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Licensing Program Analyst (LPAs) Marissa Soto and Christopher Jackson met with Licensee Amy Fuller for an unannounced random annual inspection and toured areas of the home accessible to children in care. Off-limit areas include entire upstairs and garage. Licensee acknowledged that children may never enter these off-limit areas. The census included 13 children one infant and the rest are toddlers. Also present was licensee’s staff Laurie Barnum and staff Ashlend Rodriguez and Mother in law Rieko Fuller. Licensee stated there are no new residents in the home since licensure. All Adult residents have criminal record clearances.

LPA observed current CPR/First Aid certificates which expire on 5/2020. LPA discussed recent changes in licensing requirements, including the posting of licensing inspection notices and reports and Parent Notification Requirements. LPA reviewed some children’s files. LPA observed fire drills were conducted at least once every six months and documented.

LPA observed that there were no hazardous items accessible to children.LPA observed Fireplace which was screened. LPA observed that cleaning materials were inaccessible. Licensee stated there are no weapons in the home. Fire extinguisher, smoke detector and carbon monoxide detector meet regulation. Toys appear to be safe. The backyard is fenced and gated. There are no bodies of water observed.

LPA discussed recent changes in licensing requirements, including SB 277 (no longer accepting religious beliefs for immunization's) and SB 792 pertaining to immunization requirements for children and staff - Licensee provided proof of staff immunization's.

Report continues on 809-C
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Marissa SotoTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2019
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: FULLER, AMY
FACILITY NUMBER: 573615813
VISIT DATE: 06/04/2019
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LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the licensee and provided copies. An exist interview was conducted. LPA observed the Notice of Site Visit posted and the licensee understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Marissa SotoTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2019
LIC809 (FAS) - (06/04)
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