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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485407750
Report Date: 07/09/2021
Date Signed: 07/09/2021 11:17:12 AM

Document Has Been Signed on 07/09/2021 11:17 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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:SCZEPANSKI, LACY FAMILY CHILD CARE HOMEFACILITY NUMBER:
485407750
ADMINISTRATOR:SCZEPANSKI, LACYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 628-8925
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
07/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee, Lacy SczepanskiTIME COMPLETED:
11:30 AM
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On 7/09/2021 at 10:00am, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Kirk Marks. A review of staff records on 7/07/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. There is currently one adults living in the home.

At 10:10am the home was toured inside and outside. The licensee and assistant were supervising seven children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 7:30am to 5:00pm, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the garage, and the entire upstairs which includes four bedrooms, two bathrooms and the laundry room and were made inaccessible by door safety locks and locking gates. Poisons are not stored at the home. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. There is no fireplace in the home. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection. The home is clean, orderly and comfortable. Stairs are barricaded with a locking gate. There are safe toys and equipment available for children. There is a working telephone in the home.

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SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Kirk Marks
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2021
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: SCZEPANSKI, LACY FAMILY CHILD CARE HOME
FACILITY NUMBER: 485407750
VISIT DATE: 07/09/2021
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There are cribs/play yards available for napping infants. Cribs have firm mattresses and are free of loose objects. Bedding is laundered weekly, and soiled bedding is stored inaccessible to infants. Napping infants are checked on every 15 minutes, and checks are documented on a weekly sleeping log. No infants were observed to be swaddled, and infants under 12 months are placed on their backs for sleeping.

The children use the back yard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed in the yard.

Twelve children's records were reviewed at 10:40am; required emergency information forms were observed to be on file. Individual Sleeping Plans were on file for infants under 12 months of age. The licensee has completed Mandated Reporter training. The licensee and all employees have the required immunizations on file. The licensee has current pediatric CPR and First Aid certification, which expires on 7/17/2022.

This report was reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Kirk Marks
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
LIC809 (FAS) - (06/04)
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