Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515407148
Report Date: 08/29/2017
Date Signed: 08/31/2017 02:49:30 PM

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:CANTRELL, JENNIFER FAMILY CHILD CARE HOMEFACILITY NUMBER:
515407148
ADMINISTRATOR:CANTRELL, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 329-1092
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY:14CENSUS: 0DATE:
08/29/2017
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Jennifer CantrellTIME COMPLETED:
11:05 AM
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Licensing Program Analyst Laura Chavez conducted a prelicensing inspection in response to an application for capacity of 14. A fire inspection approval was received on 8/23/2017. Days and hours of operation will be Monday-Friday; 6:30am - 6:30pm. 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 applicant is the owner. The home was toured inside and out. The floor and yard plan were verified. The residence is a three bedroom, two and half-bath home. 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. Electrical outlets were covered and cords to window blinds were not accessible. There are age appropriate toys available for the children. There is a working smoke detector, carbon monoxide detector and a fully charged fire extinguisher in the home. Notification of Parents Rights, Emergency Disaster Plan with the Earthquake Preparedness Checklist shall be posted. The bedrooms, garage, laundry room and half-bath are off-limits to children in care. These areas have been made off-limits by means of doorknob covers, and gate. The applicant understands that emergency disaster drills will be conducted and documented at least once every six months. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's visit. Poisons are locked in a hall closet and the shed located in the backyard. The applicant was advised 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. 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’s CPR and First Aid expire 9/3/2018. The applicant does not carry liability insurance for a family child care home. The applicant understands that parents will be required to sign insurance affidavits. A sample of forms typically given during prelicensing visits were provided and explained. The 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
Continued: See LIC 809-C
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 513-1214
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2017
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: CANTRELL, JENNIFER FAMILY CHILD CARE HOME
FACILITY NUMBER: 515407148
VISIT DATE: 08/29/2017
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reporting unusual incidents to CCL within 24 hours or the next business day. Incidental Medical Services (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 the following website: http://www.ada.gov/childqanda.htm. he children will use the backyard as the outdoor play area. The backyard is completely fenced. There is no trampoline, pool, spa, pond, 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 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 school aged. The applicant understands that outside employment during child care hours is not permitted. Smoking is prohibited during the hours of operation. The applicant understands the responsibility of securing copies of forms and regulations from the department's website. A copy of A Child Care Provider's Guide to Safe Sleep was provided during today's visit. This report was reviewed and discussed with applicant .

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

The home is ready to be issued a 90-day provisional license.
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 513-1214
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2017
LIC809 (FAS) - (06/04)
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