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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313625710
Report Date: 06/11/2024
Date Signed: 06/11/2024 11:21:30 AM

Document Has Been Signed on 06/11/2024 11:21 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MILLER, MARCIAFACILITY NUMBER:
313625710
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/11/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Marcia MillerTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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At approximately 9:30 a.m. on 6/11/2024, Licensing Program Analyst (LPA) Matthew Gallo met with Applicant Marcia Miller for the purpose of an announced prelicensing inspection. Applicant has requested a Small Family Childcare Home License to serve up to 8 children. Applicant's husband and adult son were also present during the inspection.

The facility is a two level home that consists of a Kitchen Area, Dining Area, Living Room, Master Bedroom and Bath, Bedroom #2, Bedroom #3, Bedroom #4, and Bathroom #2. The exterior of the facility includes a deck, detached garage, fenced play yard, garden, and a shed by the front entrance of the home, a shed on the side deck of the home, and a shed adjacent to the play yard. Off limit areas will include: Master Bedroom/Bath, Bedroom #3 (located at the back of first level hall) and Bedroom #4 (second bedroom on second level), deck, detached garage, garden, and all exterior sheds. Applicant understands that children must never enter these areas. The property is partially fenced, and Applicant acknowledges that any unfenced areas of the property require 100% supervision.

Applicant intends to operate 6:30am-6:00pm, Monday-Friday, year-round. Applicant understands they must be present at the facility for 80% of operating hours per day.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Report continues on 809-C
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2024
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MILLER, MARCIA
FACILITY NUMBER: 313625710
VISIT DATE: 06/11/2024
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LPA and Applicant toured the entire facility and property. All toxic and hazardous items are inaccessible to children and applicant understands that any cabinet containing such items and is reachable by children must be made inaccessible. Applicant also acknowledged that any poisons on the property must be stored under lock and key. LPA observed a 2A10BC fire extinguisher along with functioning smoke and carbon monoxide detectors. LPA observed a BB gun and BB ammunition stored and locked separately according to regulation. There is a hot tub spa located on the back deck which features a properly locked cover. The stairway of the home is fenced to prevent access to children, as is the fireplace in the living room.

Applicant provided proof of control of property in the form of ownership. 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’s EMSA certified CPR and First Aid Certificate expires 1/2025. Mandated Reporter Training was verified and expires 12/2024. Applicant understands the CPR/First Aid training must be renewed every two years.

LPA reviewed Safe Sleep regulations and provided the 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (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.

Report continues on 809-C
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MILLER, MARCIA
FACILITY NUMBER: 313625710
VISIT DATE: 06/11/2024
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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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

LPA reviewed with applicant 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. Entrance Checklist was provided to the applicant.



On 3/20/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

This facility evaluation report was reviewed and discussed with the applicant, Marcia Miller. A notice of site visit was given to applicant and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Effective today, 6/11/2024, the facility is issued a small license for a maximum of 6 children with no more than three infants or four infants only, or 8 children with no more than two infants and one child at least age 6 and one child enrolled and attending pre-kindergarten or elementary school.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC809 (FAS) - (06/04)
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