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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393616676
Report Date: 01/13/2022
Date Signed: 01/13/2022 01:09:23 PM

Document Has Been Signed on 01/13/2022 01:09 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:KELLY, SHARONFACILITY NUMBER:
393616676
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
01/13/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Sharon KellyTIME COMPLETED:
01:30 PM
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On Thursday, January 13, 2022 at 12:10 pm. Licensing Program Analyst (LPA) Elvira Sierra conducted a Case Management visit for the purpose of increasing the maximum capacity from 8 to 14 children. Present in the facility was Licensee, Sharon Kelly. No children were present during the inspection. Fire Safety Inspection Clearance was granted on 01/06/22 for a total capacity of 14 children. Facility hours of operation are 7 days a week 24 hours a day. All individuals subject to criminal background review have obtained a criminal record clearance.

At 12:30 pm, with the help of the Licensee, a health and safety inspection of all areas accessible to children was conducted and the following was observed. Home appears orderly and suitable for children. The Off-limits areas include; Entire upstairs, living room, laundry room, garage and the left side of the backyard. Licensee acknowledged that children may never enter these off-limit areas. Posted License, Parent's Rights, Emergency Disaster Plan, Roster of the enrolled children, and Fire Drill Log are all being maintained by the Licensee. Hazardous items were stored inaccessible to children in care. Licensee stated there are no weapons in the home and no bodies of water were observed. Fire extinguisher (2A10BC), carbon monoxide and smoke detector meet regulation. Toys appear to be safe. The backyard is fenced for supervision. The Licensee understands that in unfenced area’s 100% supervision of children is required. Licensee understand that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes.

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.
Report continues on subsequent page 809C--
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2022
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: KELLY, SHARON
FACILITY NUMBER: 393616676
VISIT DATE: 01/13/2022
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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

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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.

Capacity increase is approved as of today, January 13, 2022. The facility is licensed to serve a MAX. CAP(WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022
LIC809 (FAS) - (06/04)
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