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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 053622969
Report Date: 09/27/2022
Date Signed: 09/27/2022 03:23:14 PM

Document Has Been Signed on 09/27/2022 03:23 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:KELLY, SARAHFACILITY NUMBER:
053622969
ADMINISTRATOR:KELLY, SARAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 263-2295
CITY:ANGELS CAMPSTATE: CAZIP CODE:
95222
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
09/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Sarah KellyTIME COMPLETED:
03:30 PM
NARRATIVE
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On 09/27/2022 at 2:00 PM, Licensing Program Analysts (LPAs) Tiffanie Diep and Lauren Scott met with Licensee, Sarah Kelly, for the purpose of an unannounced annual inspection. There were ten children present at the time of inspection, four of whom were infants. Licensee's operating hours are Monday through Friday from 6:00 AM to 5:30 PM.

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 all bedrooms, the backyard, garage, and shed in side yard. LPAs observed the required postings and a working phone. 2A10BC fire extinguisher meets regulations. LPAs observed smoke and carbon monoxide detectors and verified they were both functional. LPAs toured the kitchen area and verified knives were inaccessible to children in care. LPAs observed playroom area with age-appropriate toys for children. LPAs observed hazardous and toxic items locked in cabinets in the hallway were inaccessible to children in care. Licensee stated there are weapons in the home. LPAs observed the weapons were stored according to Title 22 Regulations. There are no bodies of water on the premises. Outdoor play space is fenced.

Report continues on 809-C
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022
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: KELLY, SARAH
FACILITY NUMBER: 053622969
VISIT DATE: 09/27/2022
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Children's' files were reviewed. Emergency information and required immunization records were on file. LPAs observed a current roster and documentation 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 verified and expires 10/2023.

LPAs 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. LPAs 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. LPAs discussed the requirement to check and log infant napping every 15 minutes for infants 24 months and under. LPAs provided a copy of the 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 PIN 22-02-CCP. 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

Report continues on 809-C
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
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: KELLY, SARAH
FACILITY NUMBER: 053622969
VISIT DATE: 09/27/2022
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive e-mail communication. Licensee was encouraged to visit the Department’s website at http://ccld.ca.gov/ for information regarding child care updates, forms, regulations and legislation pertaining to Family Child Care Homes.

To improve the quality and value of the new inspection process, a survey will be sent to the e-mail address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by e-mail to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

An exit interview was conducted and report was reviewed with the licensee, Sarah Kelly. A copy of the report was provided to Licensee. A notice of site visit was given and must remain posted for 30 days.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC809 (FAS) - (06/04)
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