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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623982
Report Date: 07/27/2021
Date Signed: 07/27/2021 11:33:26 AM

Document Has Been Signed on 07/27/2021 11:33 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:ESCUE, HANNAH & AVILLA, ANDREWFACILITY NUMBER:
313623982
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
07/27/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Hannah Escue & Andrew AvillaTIME COMPLETED:
11:45 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
Licensing Program Analysts (LPA) Owens met with applicant for a capacity Increase inspection. LPA toured the home inside and out, and reviewed forms for children's records. She understands that until a policy is obtained, she must use the affidavit.

Applicant has certificates of completion for 15 hours of health and safety training including CPR and First Aid with expiration date of 6/12/2023. All adult residents received criminal record clearances. LPA reminded applicant of the applicable Civil Penalty per person for those adults including your own child who have not received fingerprint clearances, are not associated to the license, come in contact with and or provide care and supervision to the children. LPA has provided the Applicant with the web site to enable access to all updated forms, requirements and changes. Applicant understands that she needs to notify licensing for any modification inside and out of the home. The fire clearance was approved on July 23, 3031.

Off-limit areas include Garage, Laundry room, first bathroom on the left of hallway, 2nd bedroom and master bedroom. Applicant understands that children may never enter these off-limit areas. LPA reviewed the fire drill requirements. Applicant stated there are no weapons in the home. Fire extinguisher, carbon monoxide detector and smoke detectors meet regulation. Hazardous cleaning compounds are inaccessible to children. Sharp utensils and Medications are inaccessible to children. The backyard is fenced and there are no bodies of water. Applicant understands that 100% supervision is required in any unfenced areas. Applicant will supervise day care children at all times. There is no pool at the home. Family pets are inaccessible to family day care children. There are no stairs at the home. Planned hours of operation are Monday through Friday, 7 am to 4:30 pm and other hours as arranged.

Continued on page 2
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2021
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: ESCUE, HANNAH & AVILLA, ANDREW
FACILITY NUMBER: 313623982
VISIT DATE: 07/27/2021
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
LPA observed proof that licensee and staff/ volunteers have met the requirements of SB 792.

LPA observed that all staff has completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com.

LPA discussed the new Safe Sleep in Child Care regulation. LPA discussed the Effects of Lead Exposure brochure.

This facility provides Incidental medical services-IMS. LPA reviewed the storage of medication and equipment /supplies, and reviewed children and personnel records. LPA discussed the need to create a plan of operation. Specifics on the plan can be found in the family child care home evaluator manual (FCCH EM) Policy 102417.



LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

Effective today 7/27/2021 applicant is a license to serve up to either 14 children, (WHEN THERE IS AN ASSISTANT PRESENT), 12 children -No more than 4 infants. Capacity 14 - No more than 3 infants. 1 Child in Kindergarten or Elementary school and 1 child at least age 6.

Exit interview conducted.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2