Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573609448
Report Date: 02/18/2016
Date Signed: 02/18/2016 01:10:33 PM

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:LLOYD, TRACYFACILITY NUMBER:
573609448
ADMINISTRATOR:LLOYD, TRACYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 662-3437
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:14CENSUS: 5DATE:
02/18/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Tracy Lloyd, LicenseeTIME COMPLETED:
01:15 PM
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On 02/18/16, Licensing Program Analyst (LPA) Jas Jaswal arrived to conduct a random annual inspection. LPA Jaswal met with Licensee Tracy Lloyd. Five children were observed to be napping. The facility and grounds that are accessible to the children in care were toured.

The off-limit areas include the garage and the left side yard. The Licensee stated there are no new residents in the house. All adult residents of the home have criminal record clearances. The day care operates Mondays to Fridays from 8:00am to 5:00pm.

LPA Jaswal observed the posted license, Parent's Rights notice and a current disaster plan. The LPA discussed recent changes in licensing requirements, including the posting of licensing inspection notices/reports, as well as injury and incident reporting. LPA Jaswal reviewed the children's records, children's roster and staff records. Licensee Lloyd has a current First Aid/CPR certificate (expires 07/16/17). The last disaster drill was conducted on 09/24/15. Licensee does not provide child transportation. The licensee does not have any other license with Community Care Licensing (CCL).

LPA Jaswal observed that hazardous items were properly stored and out of the reach of children - on top of the refrigerator and in the off limits garage. There were no hazardous items located in the children's bathroom. LPA Jaswal observed that the weapons and ammunition are stored properly according to Title 22 Regulations. The smoke detector and fire extinguisher meet regulation. There are no bodies of water on the property. The fire place is screened. The Licensee provides meals and snacks for the children. Licensee Lloyd understands that she must notify Community Care Licensing of any proposed changes prior to making alterations or additions to the home and/or grounds.

No citations resulted from today's inspection. The exit interview was conducted with Licensee Lloyd. The Licensee also stated that she will be on vacation and the daycare will be closed 2-3 weeks in March of this year.

Notice of Site Visit posted.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Jaspreet JaswalTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2016
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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