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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313624246
Report Date: 02/08/2023
Date Signed: 02/08/2023 10:59:30 AM

Document Has Been Signed on 02/08/2023 10:59 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, KRISTYFACILITY NUMBER:
313624246
ADMINISTRATOR:FLAKE, KRISTYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 200-0995
CITY:LOOMISSTATE: CAZIP CODE:
95650
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
02/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kristie FlakeTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Amanda Blesi met with Licensee, Kristie Flake, for the purpose of an unannounced required 1-year inspection. The licensee's husband (assistant) was also present. At 10:25 a.m. LPA observed a total census of 12 children including 3 infants over 12 months.

At 10:30 a.m., Licensee guided LPA on a tour of the facility, and a health and safety inspection was conducted in all areas accessible to children. Off-limits areas include upstairs bedrooms, detached garage, well house and rear pasture. Licensee acknowledged that children must never enter these areas. LPA observed the required postings, a working phone, 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors. LPA observed weapons and ammunition locked and stored separately. LPA did not observe bodies of water at the facility. Toxic and hazardous items are inaccessible to children. Stairs were barricaded to prevent access when children under 5 are present. Outdoor play space is fenced. Licensee states no new residents have moved into the home since the last inspection.

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.

A current roster is being maintained and fire and disaster drills are documented. Current CPR and First Aid certification was verified and expires 3/2024. LPA observed AB1207 Mandated Reporter Certificate for licensee which expires 3/2024.

(Report continues LIC809-C)
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2023
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: FLAKE, KRISTY
FACILITY NUMBER: 313624246
VISIT DATE: 02/08/2023
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Infants in care today are over 12 months and use cots for napping. LPA reviewed infant sleep plan (LIC 9227) requirement with Licensee, and 15-minute observation checks of napping infants.

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 Sections 102417. When any IMS is provided an updated 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) 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

No Title 22 deficiencies were cited during today’s inspection.

Exit interview conducted and report was reviewed with the licensee Kristie Flake.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
LIC809 (FAS) - (06/04)
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