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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313616882
Report Date: 11/18/2021
Date Signed: 11/18/2021 11:54:49 AM

Document Has Been Signed on 11/18/2021 11:54 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:HALL, CATHERINEFACILITY NUMBER:
313616882
ADMINISTRATOR:HALL, CATHERINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 635-1251
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
11/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Catherine HallTIME COMPLETED:
12:00 PM
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On 11/18/2021 at 10:30 am , Licensing Program Analyst (LPA) Jeremey McClain met with Licensee Catherin Hall for an unannounced annual inspection.
LPA observed seven children, which included two infants and five preschool age children. Licensee stated there aren’t new residents in the home. Licensee’s assistant Gina Treadway was present during the inspection. All adult residents have criminal record clearances.
LPA toured areas of the home accessible to the children. The off-limit areas of the home were unoccupied and inaccessible.
LPA observed current CPR/First Aid certificate which expires 06/26/2023. LPA observed the following posted: a license, a Parents' Rights Poster and an Emergency Disaster Plan. LPA provided Licensee with website: http://childcare.mandatedreporterca.com/ and reminded the licensee that the training must be completed once every two years.
LPA reviewed children's records for completeness, as well as the client roster. LPA observed records of immunizations for MMR, Pertussis, and influenza/ influenza declination. LPA reminded licensee that children’s immunization records must be recorded on form PM 286. LPA provided a copy of the form the Licensee via email.
During the interior and exterior inspection:
LPA observed that hazardous items (detergents, cleaning compounds, medication, sharp utensils, and other items that could pose a danger to children in care) are properly stored out of children's reach.
LPA observed a fireplace that was properly screened.
LPA observed a working telephone in the home.
Licensee stated that there are no weapons in the home.
LPA observed a fire extinguisher which was last serviced on 03/2021. Carbon monoxide and smoke detectors were tested and observed to be functional. LPA observed fire drills documented on a calendar, indicating that the licensee is conducting disaster drills at least once every 6 months.
Equipment and furnishings in areas where children are active appeared to be safe and in working order.
LPA did not observe any standing bodies of water during today’s inspection. LPA advised Licensee that all areas of the playground should be adequately cushioned with bark.
REPORT CONTINUED ON THE FOLLOWING PAGE.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2021
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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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: HALL, CATHERINE
FACILITY NUMBER: 313616882
VISIT DATE: 11/18/2021
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This facility does not currently provide Incidental Medical Services- IMS. 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.


LPA discussed recent changes in licensing requirements, Safe Sleep Regulations Concepts and provided licensee with Provider Information Notice. LPA informed licensee that 15 minute sleep checks for all infants must be documented and available for review during inspection.

No deficiencies were observed during today’s inspection.



This report was reviewed with licensee, and an exit interview was conducted.

A Notice of Site Visit was provided and should remain posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC809 (FAS) - (06/04)
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