313624246-3-17-2022-03-CC-ABLI-CCLMX2-20220317095914

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313624246
Report Date: 03/17/2022
Date Signed: 03/17/2022 09:59:20 AM

Document Has Been Signed on 03/17/2022 09:59 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:	FLAKE, KRISTY		FACILITY NUMBER:	313624246
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 1	DATE:	03/17/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Kristy Flake		TIME COMPLETED:	10:30 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

At 8:30 a.m. Licensing Program Analysts (LPAs) Amanda Blesi and Ariana Manabat met with applicant Kristy Flake for a pre-licensing inspection. Also present was applicant spouse and infant child. Applicant has requested a small Family Childcare License to serve up to eight children. LPAs toured the home inside and outside. Facility is a two-story house that consists of 3 bedrooms, and 3 bathrooms. Off-limit areas consist of entire upstairs, detached garage, locked well house, second fenced area in the backyard (pasture area). Applicant understands that children may never enter the off-limit areas. The back yard is fully fenced, and applicant understands that 100% supervision is required in outside areas that are not fully enclosed by a fence. No bodies of water were observed.

Applicant 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

Applicant provided a lease agreement for control of property. Applicant understands that until a liability insurance coverage in the amount of $300,000 is provided, the affidavit form LIC282 form will be used. Applicant is registered for CPR/First Aid on March 26, 2022 and will submit a copy of her cards once the class is completed. She has completed Preventative Health and Safety Training. Applicant understands she must be present at the facility for 80% of operating hours.

Mandated Reporter training (AB 1207) was discussed. Applicant’s Mandated Reporter Certificate expires 3/13/2024. Applicant understands the training must be renewed every two years

LPA provided and discussed the Lead Testing brochures (AB 2370)

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022

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 3

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: FLAKE, KRISTY	FACILITY NUMBER: 313624246
	VISIT DATE: 03/17/2022

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

CONDITIONS REQUIRING CORRECTION PRIOR TO EXPIRATION OF THE PROVISIONAL LICENSE:

1. Applicant will send LPA the completed eight hour, Preventative Health and Safety course, which includes lead prevention component.

Effective today, LPA is granting a provisional license that will expire in 90 days on June 17, 2022.

A license is issued to serve a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child enrolled in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.

Exit interview conducted and report was reviewed with the applicant, Kristy Flake This report reviewed with Kristy Flake the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: FLAKE, KRISTY	FACILITY NUMBER: 313624246
	VISIT DATE: 03/17/2022

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

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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.

LPA did not observe a crib in the home. LPA discussed that if Licensee will be providing care to infants, there shall be one infant crib or play yard for each infant who is unable to climb out of the crib or play yard.

This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan of Operation that includes 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) 513-0301 (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.ht

COVID-19 industry guidance for child care was discussed with applicant.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3