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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485407956
Report Date: 12/22/2021
Date Signed: 12/23/2021 03:28:32 PM

Document Has Been Signed on 12/23/2021 03:28 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:STANKEWITZ, ALICIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
485407956
ADMINISTRATOR:STANKEWITZ, ALICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 635-3318
CITY:DIXONSTATE: CAZIP CODE:
95620
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
12/22/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Alicia StankewitzTIME COMPLETED:
02:15 PM
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On 12/22/2021 at 1:00pm, Licensing Program Analyst (LPA) Laura Chavez conducted a prelicensing inspection in response to an application for a capacity of 8. The applicant is the property owner. Days and hours of operation will be 24 hours a day, seven days a week. During today's inspection the applicant was caring for her minor child. The applicant understands that child care must be provided in the "primary" residence of the applicant. The applicant understands that 24 hour care shall not be provided to one child at any one time. The home was toured inside and out. The floor and yard plan were verified. The residence is three bedroom/two and a half bath, two story home. The office downstairs has been converted into a bedroom. At this time the entire second floor is off-limits to children. Baby gates have been installed at the top and bottom of the stairs. Three adults and three minors reside in the home. The home is clean and orderly at this time and will remain so during child care hours. There is a working telephone. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. Poisons are locked in the shed located in the backyard. The applicant stated that there are no weapons in the home and none were observed during the visit. There are age appropriate toys available for the children. There is a working smoke detector, and a fully charged fire extinguisher in the home. The applicant understands that the Notification of Parents Rights, Emergency Disaster Plan with the Earthquake Preparedness Checklist shall be posted. The children will use the backyard as the outdoor play area. There is no pool, spa, or ponds, nor any other source of water accessible to the children, and none of these items are to be added without prior notification and approval of the licensing agency. The applicant understands that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. All minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday and obtain a TB clearance.
Report continued: See LIC 809-C
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2021
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: STANKEWITZ, ALICIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 485407956
VISIT DATE: 12/22/2021
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The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance. The applicant understands that parents will be required to sign insurance affidavits should the applicant not does not carry liability insurance for her family child-care home. A sample of forms typically given during prelicensing inspection and COVID-19 handouts were provided and reviewed. The applicant understands that the child care roster shall remain current at all times. Children's records are to be maintained and kept current at all times. The applicant was reminded of the responsibility of reporting unusual incidents to CCLD within 24 hours or the next business day. Megan's Law is available at www.meganslaw.ca.gov/. The following information regarding the American Disabilities Act (ADA) was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at https://www.ada.gov/childqanda.htm. The applicant clearly understands the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be one child in kindergarten or elementary school and one child at least age 6. Smoking is prohibited during the hours of operation. The applicants understand the responsibility of securing copies of forms and regulations from the website. (www.ccld.ca.gov).

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

Prior to granting a regular license the following is required:
1. Proof of background clearances for Alicia Stankewitz.
2. Proof of background clearances for Bertha Rubio.
3. Submit completed COVID-19 Self-Assessment.
4. Proof of emptying the kiddie pool located in the backyard.
5. Proof of making the ladder in the backyard off-limits.
6. Proof of making the lawn mower in the backyard off-limits.
7. Proof of making both entries leading to the back of the shed off-limits
8. Proof of completion of Preventative Health Practices training.
9. Proof of making the garage off-limits to children.
10. TB clearance for Bertha Rubio.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
LIC809 (FAS) - (06/04)
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