574500090-10-14-2019-53-CC-MSOO-BGXPBQ-20191014111044

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 574500090
Report Date: 10/14/2019
Date Signed: 10/14/2019 11:11:06 AM

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:	GORHAM, MEGHAN		FACILITY NUMBER:	574500090
ADMINISTRATOR:	GORHAM, MEGHAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 721-7198
CITY:	WEST SACRAMENTO	STATE: CA	ZIP CODE:	95691
CAPACITY:	14	CENSUS: 0	DATE:	10/14/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Meghan Gorham		TIME COMPLETED:	11:20 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	Licensing Program Analysts (LPA) Marissa Soto met with applicant, Meghan Gorham, for the purpose of a pre-licensing inspection. All individuals subject to criminal background review have obtained a criminal record clearance. A health and safety inspection was conducted inside and out. The two story home has an unfenced front yard, 3 bedrooms, 3 bathrooms, a living room, dining room, kitchen, garage, and fenced backyard. The off-limits areas in the home are: entire upstairs, laundry room, garage and closet under the stairs. Off-limits areas will remain inaccessible to children by closed doors and/or supervision. The fireplace in the living room is appropriately barricaded to prevent access by children. Toxic and hazardous items are inaccessible to children. Functioning smoke and carbon monoxide detectors and a 2A10BC fire extinguisher were observed in the home. Current pediatric CPR and first aid training was verified and expires: 06/2021 . Applicant stated there are no weapons in the home. The pool is fenced per Title 22 regulations and has a self-latching gate. Gate on the pool is self-closing. Applicant was encouraged to maintain supervision at all times. LPA discussed the Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care Home must have vaccinations against, Pertussis, Measles and Influenza. A copy has been placed in applicant’s file. Report continues on 809-C

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Marissa Soto	TELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2019

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: GORHAM, MEGHAN	FACILITY NUMBER: 574500090
	VISIT DATE: 10/14/2019

NARRATIVE

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LPA discussed the Mandated Reporter Training with applicant. Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English.

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

This facility evaluation report was reviewed and discussed with the applicant. Records, postings and reporting requirements were discussed. LIC311D was provided and discussed. Applicant was encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list. childcareadvocatesprogram@dss.ca.gov

Applicant understands that anyone living or working in the home, eighteen years of age or older must obtain fingerprint clearance PRIOR to living or working in the home. Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. Applicant understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within 7 days to remain in compliance.

Report continues on 809-C

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Marissa Soto	TELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: GORHAM, MEGHAN	FACILITY NUMBER: 574500090
	VISIT DATE: 10/14/2019

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Applicant understands that if any structural changes are made to the home; licensing must be notified prior to construction. Applicant understands that if they want to make any off-limit area an ON-limits area, they must notify licensing and LPA must do an inspection BEFORE children are allowed in the area. Applicant understands that children’s records are to be maintained according to Title 22 regulations, and be accessible to licensing for up to three years.

As of today 10/14/2019 facility is approved for a Large Family Child Care Home license to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years old.
Licensee acknowledges that when there is no assistant present, facility will revert back to the small capacity. Licensee acknowledges that children residing in the home under the age of 10 years shall be included in capacity. An exit interview was conducted and notice of site visit was provided.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Marissa Soto	TELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2019

LIC809 (FAS) - (06/04)

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