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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500684
Report Date: 11/09/2022
Date Signed: 11/09/2022 12:25:59 PM

Document Has Been Signed on 11/09/2022 12:25 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:MADDOX, HOWARD & KARLAFACILITY NUMBER:
394500684
ADMINISTRATOR:MADDOX, HOWARD & KARLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 988-1236
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/09/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Karla & Howard MaddoxTIME COMPLETED:
12:45 PM
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On November 09, 2022, Licensing Program Analysts (LPAs) Elvira Sierra and Corina Beckby met with Applicants, Karla & Howard Maddox for the purpose of an announced pre-licensing inspection. All individuals subject to criminal background review have obtained a criminal record clearance. Facility is one story home with a loft, four bedrooms and two bathrooms. Applicants stated facility hours of operation will be M-F from 06:00am to 06:00pm year-round with periodic break throughout the year.

A health and safety inspection was conducted in all areas of the home as well as the outdoor area. Off-limits areas will include; Entire home except day care area, TV room, bathroom #2, office space by the daycare room and front side of the backyard. Applicants understands that if any structural changes are made to the home, Licensing must be notified prior to construction. Applicants also understands that Licensing must be notified prior to use of any off-limits area and an inspection must be completed by an LPA before children are allowed in the area. Homes is cleaned and suitable for children. Age appropriate toys and reading material were observed. LPAs verified all medication/knives, toxic and hazardous items were inaccessible to children. LPAs observed cleaners stored in the garage out of reach and inaccessible to children. A 2A10BC fire extinguisher and dual functioning smoke and carbon monoxide detector was observed near the daycare area. First aid kit was observed and is kept in the emergency backpack. Applicants stated there are no weapons in the home. Home has a hot tub. LPAs observed a chimney in the off limits living room that is barricaded. The outdoor play area is fenced for supervision. Facility will provide meals.

Applicants owns the home provided proof of control of property. LPAs reviewed the fire drill requirements. The Applicants has certificates of completion for Preventative Health and Safety training including CPR/First Aid (expires 01/2024): and Mandated Reporter Training (expires: 08/26/24).
Report continues on subsequent page 809C--
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2022
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: MADDOX, HOWARD & KARLA
FACILITY NUMBER: 394500684
VISIT DATE: 11/09/2022
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Applicants, 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 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 the applicants, 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 applicants 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

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.

Report continues on subsequent page 809C--
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
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: MADDOX, HOWARD & KARLA
FACILITY NUMBER: 394500684
VISIT DATE: 11/09/2022
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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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

Licensee will be granted upon the following corrections:
-Electrical cords in the TV room must be made inaccessible to children.
-Left and Right side of the backyard mus be made inaccessible.
-Hot tub cover must be locked with a locking mechanism that requires a key or tool to unlock or remove.
-Post all required information in a place visible to parents

Exit interview conducted. This report and Appeal of Rights were provided and reviewed with applicants, Howard
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC809 (FAS) - (06/04)
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