<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624335
Report Date: 08/23/2023
Date Signed: 08/23/2023 11:00:19 AM

Document Has Been Signed on 08/23/2023 11:00 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:MATHEUS, ALYCIAFACILITY NUMBER:
343624335
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
08/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Alycia MatheusTIME COMPLETED:
11:15 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
Licensing Program Analyst Jennifer Velasco (LPA) conducted an unannounced annual inspection and met with Licensee Alycia Matheus (L1). Facility hours of operation are Monday through Friday 7:30 AM - 5:00 PM. Licensee was reminded that all adults 18 and over living or working in the home, 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.

Off limit areas include: Main bedroom, en suite main bathroom, garage, and laundry room. L1 acknowledged that children may never enter these off-limit areas. LPA conducted a health and safety inspection and observed that the facility is clean, safe, sanitary, and in good repair with ventilation. LPA observed the required documents were posted where visible to parents. LPA observed that there were no hazardous items—such as cleaning compounds, medications, or sharp objects—accessible to children. The fire extinguisher appeared to be in working condition and accessible. LPA observed the smoke and carbon monoxide detectors are functioning. The facility has equipment and toys safe for children. The backyard is fenced and L1 acknowledged that in areas that are not fenced, 100% supervision is required. There is a trampoline in the side yard; there is a lock on the trampoline, which is not used during hours of care. L1 stated there are no guns on the premises. LPA did not observe any bodies of water on the premises. Licensee will provide breakfast and two snacks, and parents will provide lunch.

LPA observed a current children's roster and fire drill log. LPA reviewed children’s files and observed that all the required documentation was present in each child's file. LPA observed the CPR/First Aid certificate was current. LPA observed a current Mandated Reporter certificate for L1 and assistant(s). L1 was reminded the Child Care portion must be completed every two years. LPA reviewed staff and facility files and observed the required documentation.

Page one of two.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2023
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 2
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: MATHEUS, ALYCIA
FACILITY NUMBER: 343624335
VISIT DATE: 08/23/2023
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
26
27
28
29
30
31
32
LPA discussed with L1 the safe sleep regulations and the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed L1 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. L1 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.

L1 applied for a change in capacity, and the fire clearance was granted by the Fire Marshal on 08/21/2023.
Effective today, 08/23/2023, Licensee’s request for a Large Family Child Care Home (FCCH) license is approved. Licensee can now provide care for 12 children (when there is an assistant present) with no more than four infants, or capacity of 14 children when one child is in transitional kindergarten, kindergarten, or elementary school and one child is at least age six, with a maximum of 3 infants. Infants are children under the age of two years. Licensee was advised and stated they understand that when there is no assistant present, the ratio and capacity limitations of a small FCCH apply and must not be exceeded.

Exit interview was conducted and report was reviewed with L1. During the exit interview, L1 confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. A notice of site visit was given and must remain posted for 30 days.

Page two of two.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2