394500810-5-23-2023-53-CC-TLAE-CS4Q4J-20230523115025

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500810
Report Date: 05/23/2023
Date Signed: 05/23/2023 11:50:38 AM

Document Has Been Signed on 05/23/2023 11:50 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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	RO, RANDY		FACILITY NUMBER:	394500810
ADMINISTRATOR:	RANDY RO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 276-6111
CITY:	LODI	STATE: CA	ZIP CODE:	95242
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	05/23/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Applicant, Randy Ro		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 05/023/2023 at 10:00 AM, Licensing Program Analyst (LPA) Tobias Lake met with Applicant, Randy Ro, for the purpose of a pre-licensing inspection. LPA was accompanied by Applicant during the inspection. Applicant's tentative operating hours are Monday through Friday from 6:00 AM to 5:30 PM. A fire clearance was granted by Lodi Fire Department on 05/03/2023. A health and safety inspection of the home’s interior and exterior was conducted. The one-story home has three bedrooms and three bathrooms. There is also a family room, living room, laundry room, garage, and kitchen area. LPA verified all knives and toxic and hazardous items were inaccessible to children. LPA observed cleaners stored in kitchen cabinets out of reach and inaccessible to children. Functioning smoke and carbon monoxide detectors were observed. A 2A10BC fire extinguisher was observed in the kitchen. Applicant stated there are no weapons or pets in the home. LPA observed a fireplace that was barricaded by a glass door and blocked by the living room television. The outdoor play area was inspected and is surrounded by a fence. Applicant understands 100% supervision of children is required in unfenced play areas. LPA did not observe bodies of water on the premises. The off-limits areas in the home include all bedrooms, the bathroom near the bedrooms, and the garage. Applicant understands off-limits areas will remain inaccessible to children in care by baby gates, doorknob covers, locked doors, and/or baby latches. Applicant understands that if any structural changes are made to the home, Licensing must be notified prior to construction. Applicant 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. Continues on 809-C

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Tobias Lake
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: RO, RANDY	FACILITY NUMBER: 394500810
	VISIT DATE: 05/23/2023

NARRATIVE

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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.

LPA discussed the mandated reporter training requirement with Applicant. Health and Safety Code 1596.8662 requires all licensed child care providers, applicants, administrators, and employees of a licensed child care facility to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicant’s current Mandated Reporter Training certificate expires on 07/30/2023. Current pediatric CPR and first aid training was verified and expires on 04/23/2024. LPA discussed the requirement to renew CPR and first aid certifications every two years prior to expiration. Completion of preventative health and safety training including nutrition and lead exposure was verified.

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 Applicant 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 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, for infants under 12 months.

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

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SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Tobias Lake
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: RO, RANDY	FACILITY NUMBER: 394500810
	VISIT DATE: 05/23/2023

NARRATIVE

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LPA reviewed with Applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to Applicant. Applicant understands that records for children and staff, including a current children’s roster, are to be maintained according to Title 22 Regulations and accessible to Licensing for up to three years. Proof of required immunizations for Applicant was verified. Applicant understands that fire and disaster drills must be conducted and documented once every six months. Applicant understands that if an unusual incident occurs, a report shall be made to the Department by telephone, e-mail, or fax within 24 hours and the LIC 624B, Unusual Incident/Injury Report - Family Child Care Home, shall be submitted within seven days to remain in compliance. Applicant understands that licenses are not transferrable, and once licensed, the licensee must live in the home and be present for 80% of the operating hours.

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 e-mail communication. Applicant was encouraged to visit the Department’s website at http://ccld.ca.gov/ for information regarding child care updates, forms, regulations and legislation pertaining to Family Child Care Homes.

A license for a large Family Child Care Home is granted effective today, May 23, 2023. The facility is approved to serve a capacity of 12 children (when there is an assistant present) with no more than 4 infants, or up to 14 children with no more than 3 infants, 1 child enrolled in transitional kindergarten or above, and 1 child at least age 6. Infants are children under the age of 2. Without an assistant present, the ratios revert to those for a small Family Child Care Home. Applicant understands that landlord consent must be on file to care for 13-14 children at one time.

An exit interview was conducted and report was reviewed with the applicant, Randy Ro.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Tobias Lake
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC809 (FAS) - (06/04)

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