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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500592
Report Date: 11/08/2022
Date Signed: 12/09/2022 12:03:01 PM

Document Has Been Signed on 12/09/2022 12:03 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:WARD, HANNAFACILITY NUMBER:
394500592
ADMINISTRATOR:HANNA WARDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 210-8420
CITY:LOCKEFORDSTATE: CAZIP CODE:
95237
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
11/08/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Hanna WardTIME COMPLETED:
01:30 PM
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 Licensing Program Analyst (LPA) Erwin Tjhia and Licensing Program Manager (LPM) Bettina Engelman met with Applicant, Hanna Ward for the purpose of conducting a change of location inspection. Present during the inspection was applicant, a relative and three children. Applicant's fiance arrived home later on. Licensee is requesting a change of location from old facility with license # 393621938 to current location.

All adults living and working in the facility have a criminal record clearances. Applicant 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.

The facility is a one story home that consists of 5 bedrooms, and 2 bathrooms. LPA and applicant toured the entire home inside and outside. Off limit areas consist of the master bedroom, bathroom in master bedroom, pet room, and garage. Ms. Ward acknowledged that children are never allowed in the off limit areas. Off limit areas will remain inaccessible by door handle covers, locked closed doors and supervision. Licensee understands that 100% supervision is required when children play any unfenced areas. Home has a swimming pool that is separated from the yard area by a 5-feet iron fence and a self-latching, self-closing gate that meets regulation.

LPA discussed licensing requirements with Licensee including the posting of licensing inspection notices and reports, as well as injury and incident reporting. Fire extinguisher type 2A10BC is located in the playroom. Smoke alarm and carbon monoxide detectors were observed to be in operational order. The weapons in the home are stored in a locked combination safety box and the ammunition are stored separately in other locked sturdy box.

Continue 809-C.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2022
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: WARD, HANNA
FACILITY NUMBER: 394500592
VISIT DATE: 11/08/2022
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Applicant was reminded that the Mandated Reporter Training Certificate need to be renewed every two years. Licensee stated that she will send LPA the renew Mandated Reporter Certificate. Current pediatric CPR and first aid training was verified and expires 08/2024. LPA discussed new safe sleep regulations 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. In addition, LPA discussed the requirement to check and log infant napping every 15 minutes for infants 24 months and under. LPA provided a copy of LIC 9227 Individual Sleeping Plan, for infants under 12 months, for licensee during today's inspection.

Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. LPM reminded Ms. Ward to promptly notify the Department upon relocation and to await licensure prior to caring for daycare children. 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. Applicant understands that if any structural changes or changes to off-limit areas must be reported to the Department.

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 the applicant. Records, postings and reporting requirements were discussed. Applicant was encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

As of today, a Provisional License will be approved for a Large Family Child Care Home to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years old.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
LIC809 (FAS) - (06/04)
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