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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 325407812
Report Date: 11/01/2021
Date Signed: 11/01/2021 01:35:28 PM

Document Has Been Signed on 11/01/2021 01:35 PM - 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:FAIRBANKS, JENNIFER FAMILY CHILD CARE HOMEFACILITY NUMBER:
325407812
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
11/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Licensee, Jennifer FairbanksTIME COMPLETED:
01:45 PM
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On 11/01/2021 at 12:00, a required annual inspection was made to the facility by Licensing Program Analyst (LPA), Kirk Marks. At 12:05 the home was toured inside and outside. The licensee was supervising four children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 7:30-5:30, Monday–Thursday and 7:30-2:30 on Fridays. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the master bedroom, three children's bedrooms and the garage, and were made inaccessible by security gates and door knob covers. The children do not currently use the back yard for outdoor play because work is being done there. Children are taken on walks to the park for outdoor play at this time and licensee understands that children are to be continually supervised while on these activities. The backyard is fully fenced. There were no pools or other bodies of water observed in the yard.
Four children's records were reviewed at 12:25. One staff record were reviewed at 12:20.

There are currently two adults living in the home. The 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.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Kirk Marks
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2021
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: FAIRBANKS, JENNIFER FAMILY CHILD CARE HOME
FACILITY NUMBER: 325407812
VISIT DATE: 11/01/2021
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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 [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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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)/ (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

There were no deficiencies cited during today’s inspection



Exit interview conducted and report was reviewed with the licensee, Jennifer Fairbanks..
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Kirk Marks
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC809 (FAS) - (06/04)
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