073409394-7-6-2023-02-CC-THAR-CTGRE8-20230706125708

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409394
Report Date: 07/06/2023
Date Signed: 07/06/2023 12:58:21 PM

Document Has Been Signed on 07/06/2023 12:58 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	RYBICKI, LAUREN		FACILITY NUMBER:	073409394
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS:	DATE:	07/06/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	LAUREN RYBICKI		TIME COMPLETED:	12:00 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 Analyst Alexander met today with Lauren Rybicki for an ANNOUNCED PRE-LICENSING INSPECTION. Applicant, her mother who is visiting and applicant's infant son are present for the inspection. The home is a two story house consisting of 5 bedrooms, 2.5 bathrooms, living room, kitchen, dinning room, family room and garage. The primary areas for day care will be the entire down stairs which consists of the living room, 2 bedrooms, dinning room, kitchen, and the right side of the backyard where the shed is located. These areas will be inaccessible to children in care by closed and/or locked doors, visual supervision and a safe gate at the bottom of the stairs. Applicant and husband own the home, proof was shown. Per applicant there are no firearms/weapons located on the premises. There is a 2A10BC fire extinguisher , a working smoke alarm and a working carbon monoxide detector in the home. All were tested/inspected and found to be in working condition. There are no swimming pools, hot tubs or other bodies of water located on the premises. The drawer with sharp knives located in the kitchen needs a safety lock. Cleaning solutions and medications are inaccessible to children in care. First aid kit is available and complete. The isolation area for sick children will be an area in the family room. Outdoor play will be in the fully fenced backyard. The utility shed and a/c unit located on the right side of the yard has been barricaded by a safety fence to prevent accessibility to children while at play. The licensee was instructed to anchor the play structure and make the rose bushes inaccessible to children at play as well. There are toys and play space available. Applicant was instructed to conduct and document periodic fire and disaster drills. Applicant was also informed that baby walkers, exersaucers and baby bouncers are not allowed. Applicant has completed CPR and first aid training which expires in 2/2025 respectively. Applicant has completed her 16 hours of health and safety training which included the 1 hour of Nutrition and 1 hour of Lead poisoning training. DURING TODAY'S PRE-LICENSING INSPECTION THE NEWLY IMPLEMENTED INFANT SAFE SLEEP REGULATIONS WERE DISCUSSED AND MATERIALS WERE GIVEN. APPLICANT HAS SEVERAL PLAY PENS AVAILABLE FOR INFANT SLEEPING. All forms can be downloaded at www.ccld.ca.gov. www.myccl.gov for day-care updates.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: RYBICKI, LAUREN	FACILITY NUMBER: 073409394
	VISIT DATE: 07/06/2023

NARRATIVE

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Mandated reporter and appeal rights were discussed. Licensing forms were reviewed and copies given to applicant. Applicant was reminded 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.
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

As a result of today's visit the following needs to be corrected before a license can be issued.

1. Play structure located in the backyard needs to be anchored into the ground for children's safety
2. The rose bushes located near the play structure need to be made inaccessible to children in care or removed altogether.
3.The knife drawer in the kitchen needs a safety lock
4. The miscellaneous ./junk drawers in the kitchen need safety locks

An exit interview was conducted

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC809 (FAS) - (06/04)

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