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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293623223
Report Date: 11/19/2021
Date Signed: 11/19/2021 12:19:49 PM

Document Has Been Signed on 11/19/2021 12:19 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:KEMPLIN, BETHFACILITY NUMBER:
293623223
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
11/19/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Beth Kemplin - LicenseeTIME COMPLETED:
12:40 PM
NARRATIVE
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On Friday, November 19th, 2021, at 11:14am, Licensing Program Analyst (LPA) Blake Morillas conducted a Case Management visit for the purpose of increasing capacity from 8 to 14 children. At 11:14am LPA informed the Licensee, Beth Kemplin, of the reason for the inspection. At 11:19am, 7 children were observed along with the Licensee and her husband. Licensee stated there are no new residents in the home.

The 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.


At 11:19am, LPA initiated a health and safety inspection of all areas accessible to children.

Off-limits areas include the Garage and all Bedrooms. Licensee acknowledged that children may never enter these off-limit areas.

LPA observed current CPR/First Aid certificates (expires: 8/2022), posted License, Parent's Rights and current emergency disaster plan. A current roster of the enrolled children and fire drill log was observed.

The Fire Safety Inspection Clearance has been received and the home has been cleared for up to 14 children.

*Continued on LIC 809-C
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SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Blake Morillas
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: KEMPLIN, BETH
FACILITY NUMBER: 293623223
VISIT DATE: 11/19/2021
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*Continuation of LIC 809
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Hazardous items were stored inaccessible to children in care. Licensee stated there are no weapons in the home.

Fire extinguisher (2A10BC), carbon monoxide and smoke detector meet regulations. Toys appear to be safe.

The backyard is fenced. The Licensee understands that in unfenced area’s 100% supervision of children is required.

There is a pool at the home. The swimming pool in the backyard is fenced with a self-latching and self-closing gate.

Licensee understands that prior to making alterations or additions to the home or grounds, the Licensee shall notify the Department of the proposed changes.

LPA provided and discussed the Safe Sleep in Child Care regulations as well as current Covid-19 guidelines.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.



Capacity increase is approved as of 11/19/2021.

The facility is licensed to serve a MAX. CAP(WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

A notice of site visit was given and must remain posted for 30 days.

At 12:15pm, an exit interview conducted and report was reviewed with the Licensee, Beth Kemplin.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Blake Morillas
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
LIC809 (FAS) - (06/04)
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