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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500732
Report Date: 11/08/2022
Date Signed: 11/08/2022 01:30:58 PM

Document Has Been Signed on 11/08/2022 01:30 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:MCLANE, ALICEFACILITY NUMBER:
394500732
ADMINISTRATOR:MCLANE, ALICEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 750-8599
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY: 9TOTAL ENROLLED CHILDREN: 9CENSUS: 0DATE:
11/08/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Alice McLaneTIME COMPLETED:
02:00 PM
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On 11/08/2022, Licensing Program Analyst Katy Maestas (LPA1) and Licensing Program Analyst David Nguyen (LPA2) met with Applicant Alice McLane (A1) for the purpose of a pre-licensing inspection. LPA1 disclosed the purpose of the inspection and was granted entrance into the Family Childcare Home (FCCH). LPA1 provided the Entrance Checklist to A1. Also present in the FCCH was A1's adult son and adult daughter-in-law. All individuals subject to criminal background review have obtained a criminal record clearance verified by LPA1 accessing Guardian. A1’s tentative hours of care are Monday through Friday, and open at all hours to provide overnight care. A1 does not intend on providing weekend care.

A health and safety inspection was conducted inside and outside of the FCCH. A1 accompanied LPA1 and LPA 2 for the entirety of the tour. The home is a two-story house. The 1st floor consists of a bedroom, bathroom, playroom, kitchen, and access to the garage. The 2nd floor consists of a loft, laundry room, bathroom, 3 bedrooms, master bedroom and bathroom. LPA1 verified that toxic and hazardous items were inaccessible to children in care. LPA1 did not observe any fireplaces. LPA1 observed the stairs properly barricaded by a baby-gate. The front yard was toured as was the backyard and side yards. LPA1 verified that the entirety of the backyard is fenced-in and walked the perimeter to ensure the safety of the fence and gate. However, the backyard is not yet landscaped. A1 stated that she will utilize the park within her housing development for outside play until the backyard is completed. A1 understands that 100% supervision is required at the park. LPA1 did not observe any pool, spa nor water feature. A1 stated that her FCCH houses 2 indoor cats and a fish tank. The OFF-limits areas of the FCCH are the 1st floor bedroom, garage, the entirety of the 2nd floor, the front yard, backyard, and side yards. A1 understands that OFF-limits areas must remain inaccessible to children in care.

A functioning dual smoke and carbon monoxide detector was observed and tested in the hallway near the garage. LPA1 observed cleaners stored in the kitchen and laundry room that are out of reach of children in care. A SV-466393 fire extinguisher was observed in the green and will be serviced by the local fire department. LPA1 observed a first aid kit stored in the closet on the 1st floor. A1 stated there are no firearms or weapons in the home. Continued on 809-C

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
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: MCLANE, ALICE
FACILITY NUMBER: 394500732
VISIT DATE: 11/08/2022
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LPA1 discussed Mandated Reporter Training with A1. Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their Mandated Reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English and Spanish. A1 has a current Mandated Reporter Training Certificate which will expire on 10/21/2023. Current Pediatric CPR and First Aid training was verified and expires on 06/2023. Completion of Preventative Health and Safety training, including nutrition and lead exposure, was verified before the inspection. Proof of required immunizations for A1 was also verified before the inspection.

LPA1 discussed the Safe Sleep Regulations with A1 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. LPA1 also informed A1 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. LPA1 discussed the requirement to check and log infant napping every 15 minutes for infants under 24 months. LPA provided a copy of the LIC 9227, Individual Sleeping Plan, to be completed for infants under 12 months.

Incidental Medical Services (IMS) policy was discussed with A1. 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.



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.

Continued on 809-C

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
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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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: MCLANE, ALICE
FACILITY NUMBER: 394500732
VISIT DATE: 11/08/2022
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A1 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.

A1 understands that licenses are not transferable, and once licensed, Licensee must live in the home and be present for 80% of the operating hours. A1 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. A1 understands that if any structural changes are made to the FCCH; Licensing must be notified PRIOR to construction.



A1 understands that if she wants to make any OFF-limits area an ON-limits area, she must notify Licensing and LPA must do an inspection BEFORE children are allowed in said area. A1 understands that children’s and staff’s records are to be maintained according to Title 22 regulations and be accessible to Licensing for up to 3 years. LPA reviewed with Licensee 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. A1 understands that fire drills must be conducted and documented once every six months.


As of today, 11/08/2022, A1 is approved for a Small Family Child Care Home license for a capacity of 8 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.

An exit interview was conducted, and the report was reviewed with A1. Licensee Appeal Rights were provided. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
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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