<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093624494
Report Date: 09/28/2022
Date Signed: 09/28/2022 10:16:51 AM

Document Has Been Signed on 09/28/2022 10:16 AM - 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:UTRILLA, DANIELLEFACILITY NUMBER:
093624494
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
09/28/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Danielle UtrillaTIME COMPLETED:
11:00 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
On September 28th, 2022 at 9:00am, Licensing Program Analyst (LPA) Arianna Manabat met with applicant, Danielle Utrilla, for the purposes of a scheduled pre-licensing inspection at the facility. The applicant lives in a one-story house with two children. Licensee is aware that her own children are included in the ratio if they are present in the home and under 10 years of age. All the adults living in the facility have a criminal background clearance on file.

The hours of operation will be Monday to Friday 8:00 AM to 6:00 PM. The facility off limit areas include all bedrooms, shed, and the laundry room. The applicant has stated that they would use the front living room as the isolation area in the event that children become suddenly ill. Applicant was notified that they would need to contact the department before making any on-limits areas to off-limits or vice versa.

LPA inspected the entire home with the applicant for health and safety hazards. All of the toxic or dangerous materials are inaccessible. The facility has a working telephone, fully charged fire extinguisher, first aid supplies, smoke detector, and carbon monoxide detector that meets regulations. As per the applicant, there are no firearms/ weapons or bodies of water within the facility. Cabinets in the kitchen and drawers do not possess potential hazards inside. Knives are stored in an area inaccessible to children atop the fridge. Per the Licensee, the discipline policy will be to talk to the child and to redirect them.

Applicant was advised that all adults, 18 years and older living in the home, helper or assistant must have obtained a criminal record clearance and must be associated to the facility prior to working in the facility. This can be done by submitting an fingerprint form LIC 9182 with copy of CA DL or CA ID prior to having any contact with children in care. Failure to do so could result in an immediate civil penalty of $100.00 each day.

See next LIC 812-C for continuation ...........
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2022
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: UTRILLA, DANIELLE
FACILITY NUMBER: 093624494
VISIT DATE: 09/28/2022
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
Continuation from LIC 812...........

LPA discussed the licensing regulations, safe sleep procedures, and provided applicant with information on how to access PINs online at the CCLD website. Applicant has submitted record of all the required immunization, CPR, and mandated reporter. Applicant understands that these need to be updated every two years. Applicant understands that fire/earthquake drills are to be conducted every 6 months and recorded. The applicant understands that baby walkers and smoking are prohibited within the facility.

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.

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



A copy of this report was reviewed and provided to applicant. This report will be kept in the facility file and will be made available for public review upon request. The Sacramento Regional Office is available Monday through Friday between 8 AM - 5 PM at (916) 263-5744.

EFFECTIVE TODAY, 09/28/2022, THE FACILITY IS LICENSED FOR A MAXIMUM OF 6 CHILDREN - NO MORE THAN THREE INFANTS OR FOUR INFANTS ONLY. OR, 8 CHILDREN, NO MORE THAN 2 INFANTS AND ONE CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL, AND ONE CHILD AT LEAST SIX YEARS OF AGE. OFF-LIMITS AREAS: BEDROOMS, LAUNDRY ROOM, AND SHED.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2