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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125407742
Report Date: 12/01/2021
Date Signed: 12/01/2021 01:48:56 PM

Document Has Been Signed on 12/01/2021 01:48 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:KELLEY, MORGAN FAMILY CHILD CARE HOMEFACILITY NUMBER:
125407742
ADMINISTRATOR:KELLEY, MORGANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 599-4492
CITY:WILLOW CREEKSTATE: CAZIP CODE:
95573
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
12/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Morgan KelleyTIME COMPLETED:
02:30 PM
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On 12/01/21 at 10:30 AM, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Kiriko Lynch. At 10:30 AM the home was toured inside and outside. The licensee and 2 assistants were supervising 10 children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 8:30 AM - 4:00 PM, Monday–Thursday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are: two detached bedrooms, laundry room, fenced off back property area , and were made inaccessible by child safe knobs, gates/fencing, and/or locked doors. The children use the front yard as the outdoor play area and it fully fenced. There is a hot tub with a locked cover in an off-limits fenced and locked area. Ten children's records were reviewed at 11:30 AM. Three staff records were reviewed at 12:30 PM. The Licensee was reminded that all adults 18 and over living or working in the home, 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. 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 There were no deficiencies cited during today’s inspection. Exit interview conducted and report was reviewed with the licensee Morgan Kelley.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Kiriko Lynch
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2021
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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