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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293623223
Report Date: 02/10/2022
Date Signed: 02/10/2022 03:55:54 PM

Document Has Been Signed on 02/10/2022 03:55 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:KEMPLIN, BETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 205-9608
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95945
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
02/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Beth Kemplin - LicenseeTIME COMPLETED:
04:10 PM
NARRATIVE
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On Thursday, February 10th, 2022, at 1:45pm, Licensing Program Analyst (LPA) Blake Morillas met with the Licensee, Beth Kemplin, for the purpose of an unannounced Annual Required inspection. The Licensee's husband was also present upon arrival. At 1:47pm, 1 infant 7 preschool age, and 1 school age child were observed.

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.

The operating hours are 7:30am to 5:45pm, Monday through Friday, year around.



At 1:50pm, LPA initiated a health and safety inspection of all areas accessible to children. At the onset of the inspection the Licensee requested that she would like to update their Off-Limit areas by making the back bedroom an "on-limit" area and adding the outdoor shed as an Off-limit area. The bedroom was inspected and found to be compliant with Title 22 regulations.

The UPDATED Off-limits areas include the Front Bedroom, Master Bedroom/Bathroom, Outdoor Shed, Garage. Licensee acknowledged that children may never enter these off-limit areas.

LPA observed a working phone, fire extinguisher, and functioning smoke and carbon monoxide detectors.

*Continued on LIC 809-C
Page 1 of 3
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Blake Morillas
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2022
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 3
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: 02/10/2022
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*Continuation of LIC 809

Licensee stated there are no weapons in the home. Toxic and hazardous items (detergents, cleaning compounds, medications, sharp utensils, items that could pose a danger to children in care) are properly stored and inaccessible to children. There is no fireplace at the home. There are stairs in the home which are properly barricaded. Safe toys and play equipment are observed.

The outdoor play space is fenced. The Licensee understands that in unfenced outdoor areas, 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.

At 2:31pm, LPA began to review Children’s files and other documentation. A current roster is being maintained. Licensee's fire and disaster drills are conducted and documented. Preventative health training, current pediatric CPR and First Aid certification was verified for the Licensee (expires 8/2022). Mandated Reporter Training (AB 1207) for Licensee was also verified.

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.

Continued on LIC 809-C

Page 2 of 3

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

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: 02/10/2022
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Continuation of LIC 809-C

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: http://www.ada.gov/childqanda.htm



LPA discussed current Covid-19 guidelines with the Licensee.

Licensee was encouraged to visit the Department website at http://ccld.ca.gov for child care updates, current forms, legislation, and regulation information.

In the areas that were evaluated, there were no deficiencies at this time.

To improve the quality and value of the new inspection process, a survey will be sent to the email 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 email 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/process.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Beth Kemplin.

Page 3 of 3

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

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
LIC809 (FAS) - (06/04)
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