313624959-5-25-2023-03-CC-MGAO-CS6NT8-20230525104420

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313624959
Report Date: 05/25/2023
Date Signed: 05/25/2023 10:44:30 AM

Document Has Been Signed on 05/25/2023 10:44 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:	WITZ, JEANNETTE		FACILITY NUMBER:	313624959
ADMINISTRATOR:	WITZ, JEANNETTE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 386-8436
CITY:	MEADOW VISTA	STATE: CA	ZIP CODE:	95722
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	05/25/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Jeannette Mitz		TIME COMPLETED:	10:50 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 9:15 a.m. Licensing Program Analyst (LPA) Matthew Gallo met with applicant Jeannette Witz for a pre-licensing inspection. Applicant's husband was also present. LPA toured the home inside and outside. Facility is a three-level house that consists of 4 bedrooms, and 5 bathrooms. Off-limit areas consist of all areas in the house except for the primary child care room and the attached covered patio/sunroom. 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. All adults residing in the home have received a criminal record clearance. 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. LPA conducted a health and safety inspection of the premises. There is a pool on the property that is properly fenced according to regulations, with a 5' fence and a self-latching gate that opens outward. Applicant stated that there are no weapons in the home. Toxic and hazardous items, sharp utensils, and medications are inaccessible to children. Carbon monoxide and smoke detectors meet regulation. There is a heater in the covered patio/sunroom that has a facade of a fireplace but does not reach temperatures that could cause harm to a child. Applicant provided a copy of deed for control of property and understands that until a liability insurance coverage in the amount of $300,000 is provided, the affidavit form LIC282 form will be used. Applicant submitted proof of current CPR/First Aid (expiring 5/24/2025) and completion of 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 verified and expires 7/23/23. Applicant understands the training must be renewed every two years. (Report continued on the following page, LIC 809-C…)

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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: WITZ, JEANNETTE	FACILITY NUMBER: 313624959
	VISIT DATE: 05/25/2023

NARRATIVE

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LPA discussed the Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care Home must have vaccinations against, Pertussis, Measles and Influenza. Proof of required vaccines are in the facility file. LPA provided and discussed the Lead Testing brochures (AB 2370).

Applicant stated that they do not intend to provide care to infants. 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. Applicant understands that infants must be checked on every 15 minutes and documentation shall be kept in a sleep log which shall be made available upon request.

LPA discussed the safe sleep regulations with applicant 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 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.

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

Exit interview conducted and report was reviewed with the applicant Jeannette Witz.

Effective today, 5/25/2023, applicant is licensed for a Large Family Child Care License to serve 12 children (when there is an assistant present) with no more than 4 infants, or capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or above and 1 child at least age 6 with a maximum of 3 infants. Infants are children under the age of 2.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

LIC809 (FAS) - (06/04)

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