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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045408198
Report Date: 10/18/2022
Date Signed: 10/18/2022 02:49:49 PM

Document Has Been Signed on 10/18/2022 02:49 PM - It Cannot Be Edited

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:BOYNE, KIERSTI FAMILY CHILD CARE HOMEFACILITY NUMBER:
045408198
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
10/18/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Kiersti BoyneTIME COMPLETED:
03:00 PM
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A pre-licensing inspection was conducted today at 1:50 pm by Licensing Program Analyst (LPA), Wisehart. LPA met with licensee Kiersti Boyne. The licensee is requesting a license for a capacity of 8. The facility will operate Monday-Friday, 7:30 am to 5:30 pm. The residence is a 3 bedroom/2 bath single story home. There is one adult and 1 minor currently living in the main home and one adult living in the home by the detached garage. Both homes are on the same property but have different addresses per licensee.
The home and yard were toured, and the facility sketch was verified. The following areas will be off limits to children: The master bedroom/bathroom; and one bedroom are inaccessible. These areas have been made inaccessible by means of door knob covers. The home has a living room; quiet nap room; hallway bathroom; dining room and kitchen accessible to children. The Laundry room has a door knob cover on it but children use laundry room to access the outdoor play area; so licensee understands the need to keep laundry chemicals inaccessible or locked. Poisons are locked in detached garage. The home is equipped with a working smoke detector and fire extinguisher rated at least 2A10BC. The wood stove insert is not currently in use. The licensee has a fire screen which has not been secured yet. The licensee understands that prior to use of the wood insert, the fire screen must be secured. The children will use the backyard as the outdoor play area. The backyard is completely fenced.
LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Carrie Wisehart
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2022
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: BOYNE, KIERSTI FAMILY CHILD CARE HOME
FACILITY NUMBER: 045408198
VISIT DATE: 10/18/2022
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Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
Exit interview conducted and report was reviewed with the licensee Kiersti Boyne.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Carrie Wisehart
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022
LIC809 (FAS) - (06/04)
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