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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623990
Report Date: 07/06/2021
Date Signed: 07/06/2021 10:10:24 AM

Document Has Been Signed on 07/06/2021 10:10 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:BOOKER, SARAHFACILITY NUMBER:
343623990
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
07/06/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Sarah BookerTIME COMPLETED:
10:25 AM
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On Tuesday, 07/06/21, at 8:40am, Licensing Program Analyst (LPA) Jan Hoshida conducted an announced pre-licensing inspection due to a change of location and met with Licensee Sarah Booker. LPA observed there were no day care children present in the facility during this inspection. All individuals subject to criminal background review have obtained a criminal record clearance.

LPA and Licensee conducted a health and safety inspection inside and outside of the home. The two-story home has an unfenced front yard, four bedrooms, three bathrooms, living room connected to the kitchen and dining area, laundry room, and fenced back yard. The off-limits areas in the home are bedroom #2, master bedroom #3, master bathroom, laundry room, garage, and entire upstairs. Off-limits areas will remain inaccessible to children by closed doors and/or supervision. Functioning smoke detector, carbon monoxide detector, and fire extinguisher were observed in the home. Preventative health and safety, current pediatric CPR and first aid training was verified and expires on 6/2023. No weapons in the home. There is no fireplace in the home. Supervision was discussed and applicant understands that children must be 100% supervised in unfenced yards and areas and during water play. Immediate Civil Penalty regulation and deficiencies were reviewed. LPA observed that licensing documents were posted in the hallway of the home. Licensee will be offering day care services from Monday through Friday from 6:00 am to 6:00 pm.

LPA consulted Licensee again regarding the following topics: new safe sleep regulations, Type A vs. Type B deficiencies, placement of detergents, placement of poisons, placement of medicines, announced vs. unannounced inspections, posting requirements, unusual incident reports, on-limits vs. off-limit areas, licensing file management, fire drills, 80% supervision, 100% supervision, mandated reporting, and best practices. Licensee acknowledged that she must place her poisons to be inaccessible and under lock and key and she does not have any poisons in her home at this time.

REPORT CONTINUED ON NEXT PAGE

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Jan Hoshida
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2021
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: BOOKER, SARAH
FACILITY NUMBER: 343623990
VISIT DATE: 07/06/2021
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LPA consulted regarding the requirement of AB1207 Mandated Reporter training for Licensee and Licensee’s assistant/husband. LPA explained that training must be completed once every two years.

Licensee understands that a current roster must be maintained and that a fire drill must be conducted and documented once every six months.

Licensee understands that if she wants to make any changes to on or off limit areas in the home, she must notify licensing and LPA must do an inspection BEFORE children are allowed in the areas.

Licensee understands that children’s records are to be maintained according to Title 22 Regulations and be accessible to licensing for up to three years. Licensee understands that her License, Emergency Disaster Plan, and the Parents Rights Poster must be posted in the home.

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. 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

This facility evaluation report was reviewed and discussed with the Licensee. Records, postings and reporting requirements were discussed. The Records To Be Maintained At The Facility - Family Child Care Home (LIC311D) was provided and discussed. Licensee was encouraged to visit the department website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, self-assessment guides, regulations and legislation pertaining to family child care homes. LPA also included the email address for the children's advocacy program to stay current on new laws CHILDCAREADVOCATESPROGRAM@DSS.CA.GOV.

Effective today, 07/06/21, Licensee has been approved for a license for small family child care home within her new residence. Licensee is approved for a small family child care home license to serve a capacity of 6 children with no more than 3 infants or 4 infants only. With a capacity of 8 children: no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6. An exit interview was conducted and Notice of Site Visit was posted.

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Jan Hoshida
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
LIC809 (FAS) - (06/04)
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