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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293624876
Report Date: 04/06/2023
Date Signed: 04/06/2023 10:42:50 AM

Document Has Been Signed on 04/06/2023 10:42 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:FARFAN, LORINDAFACILITY NUMBER:
293624876
ADMINISTRATOR:FARFAN, LORINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 823-7311
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95949
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/06/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Lorinda FarfanTIME COMPLETED:
10:45 AM
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At 9:35 a.m. Licensing Program Analyst (LPA) Matthew Gallo met with applicant Lorinda Farfan for the purpose of a prelicensing inspection for a change of location. Applicant was previously licensed at facility #313623552.

All individuals subject to criminal background review have obtained a criminal record clearance. 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.

The property consists of a main house, studio, and small cabin/shed. Both the studio and small cabin/shed are off-limits. Of the main house, off-limit areas include the back two bedrooms and back deck. Applicant acknowledges that child care children must never enter the off-limits area, and understands that an inspection by the department must be made prior to making an off limits area on limits. Hours of operation are 7:30AM-5:30PM, Monday thru Friday. Applicant understands she must be present at the facility for 80% of operating hours. Applicant understands that their own children under 10 years old count toward the ratio.

LPA and Applicant toured the entire facility. LPA observed functioning smoke and carbon monoxide detector and a 2A10-BC fire extinguisher. LPA reviewed the required postings with applicant. Cleaning materials, hazardous items, and medications are all stored inaccessible to children. Applicant stated that there are no firearms nor poisons in the facility and LPA observed no bodies of water on the property.

Applicant owns home and has provided proof of control of property. Current CPR and First Aid certification was verified and expires 8/2023 and AB 1207 Mandated Reporter Training was verified for the Applicant which expires on 11/2023.

Continued on LIC809-C
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2023
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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: FARFAN, LORINDA
FACILITY NUMBER: 293624876
VISIT DATE: 04/06/2023
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LPA reviewed Safe Sleep regulations and COVID-19 industry guidance for child care and observed necessary sleeping equipment for her enrolled infant. LPA further provided the 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 Applicant 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.

As of today, 4/6/2023, facility is approved for a Large Family Child Care Home license for a capacity of 12 children. Exit interview conducted with licensee and Notice of Site Visit provided. Notice of Site Visit must be posted for 30 days, and failure to comply with posting requirements will result in an immediate $100 civil penalty.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
LIC809 (FAS) - (06/04)
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