343624814-2-10-2023-03-CC-AMAT-CNWRJQ-20230210120419

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624814
Report Date: 02/10/2023
Date Signed: 02/10/2023 12:04:24 PM

Document Has Been Signed on 02/10/2023 12:04 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	HENDERSON, TIA		FACILITY NUMBER:	343624814
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	02/10/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Tia Henderson		TIME COMPLETED:	12:15 PM

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	On February 10th, 2023 at 9:00am, Licensing Program Analyst (LPA) Arianna Manabat met with applicant, Tia Henderson, for the purposes of a scheduled pre-licensing inspection at the facility. Applicant has license (343624591) for child care home at a different location and applied for new license due to change of location. The applicant lives in an apartment with one minor child. Although Licensee does not have any children under 10, she is aware that any her own children under 10 are included in the ratio if they are present in the home. All the adults living in the facility have a criminal background clearance on file. The off-limit areas include the upstairs area and garage. Facilty hours of operation are Monday through Friday from 3:00 PM to 10:00 PM. In the event children are suddenly ill, applicant is able to utilize the living room, front door area, or additional downstairs room as the isolation area. Applicant was notified that they would need to contact the department before making any on-limits areas to off-limits or vice versa. LPA inspected the entire home with the applicant for health and safety hazards. All of the toxic or dangerous materials are inaccessible. There are no pets in the facility. The facility has a working telephone, fully charged fire extinguisher, first aid supplies, smoke detector, and carbon monoxide detector that meets regulations. As per the applicant, there are no firearms or weapons in the facility. Cabinets in the kitchen and drawers do not possess potential hazards inside. Knives are stored in an area inaccessible to children atop the fridge. Per the Licensee, the discipline policy will be to talk to the child or redirect children to other activities. Applicant was advised that all adults, 18 years and older living in the home, helper or assistant must have obtained a criminal record clearance and must be associated to the facility prior to working in the facility. This can be done by submitting an LIC 9182 with copy of CA DL or CA ID prior to having any contact with children in care. Failure to do so could result in an immediate civil penalty of $100.00 each day. See next LIC 812-C for continuation ...........

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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: HENDERSON, TIA	FACILITY NUMBER: 343624814
	VISIT DATE: 02/10/2023

NARRATIVE

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Continuation from LIC 812...........

LPA discussed the licensing regulations, safe sleep procedures, and provided applicant with information on how to access PINs online at the CCLD website. Applicant has submitted record of all the required immunization, CPR valid until August 2022. Applicant understands that fire/earthquake drills are to be conducted every 6 months and recorded. The applicant understands that baby walkers and smoking are prohibited within the facility.

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 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

A copy of this report was reviewed and provided to applicant. This report will be kept in the facility file and will be made available for public review upon request. The Sacramento Regional Office is available Monday through Friday between 8 AM - 5 PM at (916) 263-5744. The facility has been cleared for Licensure as of 02/10/2022. Per Licensee, the facility will accept children into care on 02/11/2023. LPA Manabat will make the License effective as of 02/11/2023. Facility is licensed for a maximum of 6 children - no more than three infants or four infants only. The off-limit areas include the master bedroom adjacent to the hallway closet.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC809 (FAS) - (06/04)

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