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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573615874
Report Date: 07/27/2022
Date Signed: 07/27/2022 12:37:10 PM

Document Has Been Signed on 07/27/2022 12:37 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:ACKERMAN, MICHELEFACILITY NUMBER:
573615874
ADMINISTRATOR:ACKERMAN, MICHELEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 219-3501
CITY:WOODLANDSTATE: CAZIP CODE:
95776
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
07/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Michelle Ackerman TIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Chayntel Hunter and Mariya Melnichuk met with Licensee, Michelle Ackerman for the purpose of an unannounced annual inspection. There were four children present at the time of inspection. Licensee's operating hours are Monday through Friday from 7:00 AM. to 5:00 PM.

All adults subject to criminal background review have obtained criminal record clearance. Licensee was reminded that all adults 18 and over living or working in the home, 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.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include the entire upstairs, pool and the garage. Licensee requested to add bedroom 1 and the master bathroom, as off-limits areas. LPA observed the required postings and a working phone. 3B40BC fire extinguisher meets regulations. LPA observed smoke and carbon monoxide detectors, and verified they were both functional. LPA toured the kitchen area and verified knives were inaccessible to children in care. LPA observed living room area with age appropriate toys for children. LPA observed a restroom and verified that hazardous and toxic items were inaccessible to children in care. Licensee stated there are weapons in the home. LPA verified that weapons were stored in a locked safe. LPAs did not observe ammunition to be stored in the same safe. Licensee stated ammunition is stored at an off site location.
The backyard has an in-ground pool area that is fenced per Title 22 regulations and LPA observed the gate to self-close and self-latch. LPAs verified that the windows, that provide direct access into the pool area, was locked.

Report continues on 809-C.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Chayntel Hunter
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2022
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: ACKERMAN, MICHELE
FACILITY NUMBER: 573615874
VISIT DATE: 07/27/2022
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Children's files were reviewed. Emergency information and required immunization records were on file. LPA observed a current roster and discussed that a fire drill is conducted at least once every six months. Licensee's immunization records are available in the facility file. Current EMSA pediatric CPR and First Aid certification was verified and expires 03/2023 and Child Care Provider Mandated Reporter certification was discussed.

LPA discussed the safe sleep regulations with licensee 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 licensee 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 LPA provided a copy of LIC 9227 Individual Sleeping Plan for infants under 12 months.
This provider is not currently providing Incidental Medical Services (IMS) services to children in care. 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

Exit interview conducted and report was reviewed with the licensee. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Chayntel Hunter
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
LIC809 (FAS) - (06/04)
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