343625006-5-25-2023-03-CC-MGON-CS6NTQ-20230525104506

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343625006
Report Date: 05/25/2023
Date Signed: 05/25/2023 10:45:19 AM

Document Has Been Signed on 05/25/2023 10:45 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	SHOTWELL, KATHRYN		FACILITY NUMBER:	343625006
ADMINISTRATOR:	SHOTWELL, KATHRYN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 212-1201
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95834
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	05/25/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Kathryn Shotwell		TIME COMPLETED:	11:00 AM

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On Thursday, May 25th, 2023 Licensing Program Analyst (LPA) Mandie Goodwin met with Applicant Kathryn Shotwell for the purpose of an announced pre-licensing inspection. Applicant is doing a change of location from facility #343623102 and a change of capacity. During today’s inspection applicant’s partner was also present in the home. All individuals subject to criminal background review have cleared background checks. Applicant plans to operate 24/7. Overnight care was discussed.

A health and safety inspection was conducted inside and outside the home. Applicant rents a single story home which includes an entry living room, dining room, kitchen, laundry room, garage, living room, coat closet, 2 bedrooms, a bathroom, master bedroom and bathroom, and a fully fenced backyard. The off limits areas include the kitchen, the coat closet, all bedrooms, laundry room, and garage. Applicant understands that children may never access these off limit areas.

Toxic and hazardous items are inaccessible to children and out of children’s reach. LPA advised the applicant that if there are ever any poisons at the home, all poisons must be locked with a key lock or combination lock. A functioning smoke detector and carbon monoxide detector was observed, and serviced fire extinguisher that meets regulation was observed. There is a weapon stored in the home that is locked separate from the ammunition in accordance with title 22 regulation.

Applicant has completed the required Preventative Health and Safety course with the Lead Poisoning Prevention training. Current EMSA approved pediatric CPR/First Aid trainings were verified and expires 04/15/2025. LPA discussed the requirement to renew mandated reporter training every two years and provided the website mandatedreporterca.com.

Applicant was encouraged to maintain supervision at all times. Applicant understands that if an unusual incident occurs, licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within 7 days to remain in compliance. Cont. on 809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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: SHOTWELL, KATHRYN	FACILITY NUMBER: 343625006
	VISIT DATE: 05/25/2023

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LPA discussed Type A/B citations, open door policy, fire drills, children’s personal rights, and smoking prohibition with the applicant. A current roster of children enrolled must be available and maintained for a period of three years, even after children are no longer in care. Applicant’s own children under the age of 10 count towards total capacity.

LPA explained to applicant that if they relocate and wants to continue to provide care, they must submit a change of location application and have the new home inspected. Applicant understands that if they want to make any off-limit area an on-limits area, licensing must be notified and LPA must do an inspection before children are allowed in the area. Applicant understand that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. If applicant chooses to not operate the childcare anymore, licensing must be notified in writing. LPA reviewed with applicants 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.

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, 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.

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: http://www.ada.gov/childqanda.htm

PAGE 2. REPORT CONTINUES ON LIC809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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: SHOTWELL, KATHRYN	FACILITY NUMBER: 343625006
	VISIT DATE: 05/25/2023

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LPA discussed the safe sleep regulations with Applicant 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 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.

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.

Exit interview conducted and report was reviewed with Kathryn Shotwell.

As of 5/25/2023 facility is approval for a Large Family Child Care Home license for a capacity of 12 children with no more than 4 infants, or up to 14 children with no more than 3 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

LIC809 (FAS) - (06/04)

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