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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573621481
Report Date: 12/27/2021
Date Signed: 12/27/2021 02:54:58 PM

Document Has Been Signed on 12/27/2021 02:54 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:HODGE, TIFFANYFACILITY NUMBER:
573621481
ADMINISTRATOR:HODGE, TIFFANYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(618) 663-0574
CITY:WOODLANDSTATE: CAZIP CODE:
95776
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
12/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Licensee, Tiffany HodgeTIME COMPLETED:
12:45 PM
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On December 27, 2021, Licensing Program Analysts (LPAs) Chayntel Hunter and Katy Maestas met with Licensee, Tiffany Hodge for the purpose of an unannounced annual inspection. There were fourteen children present at the time of inspection. Licensee's assistant was also present during the inspection. Licensee's operating hours are Monday through Friday from 7:30 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 the entire upstairs, the garage, and the downstairs office area. Off limit areas are being made inaccessible by closed locked doors and baby gates. LPAs observed the required postings and a working phone. 3B40BC 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 and cleaners were inaccessible to children in care.

Licensee stated there are no weapons in the home. There are no bodies of water on the premises. Outdoor play space is fenced. LPAs observed play room with age appropriate toys for children. LPAs observed a restroom and verified that hazardous and toxic items were inaccessible to children in care.

Report continues on 809-C.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Chayntel Hunter
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2021
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: HODGE, TIFFANY
FACILITY NUMBER: 573621481
VISIT DATE: 12/27/2021
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LPAs discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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.

In addition, LPA discussed the infant sleep regulations with licensee. LPAs observed 15 minute infant napping logs for infants 24 months and under. LPAs observed a copy of LIC 9227 Individual Sleeping Plan, for infants under 12 months, for licensee during today's inspection.

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 for measles (MMR), pertussis (Tdap), and the flu are available in the facility file. Current in-person EMSA pediatric CPR and First Aid certification was verified and expires 07/2022 and Child Care Provider Mandated Reporter certification was verified and expires 02/2023.

LPA verified the annual fees are current.

This facility provides Incidental Medical Services (IMS). LPAs reviewed storage of medications and equipment/supplies, and reviewed children’s personnel, and administrative records. 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
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Chayntel Hunter
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2021
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: HODGE, TIFFANY
FACILITY NUMBER: 573621481
VISIT DATE: 12/27/2021
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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/inspection-process

Exit interview conducted and report was reviewed with the licensee. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for childcare updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. Licensee's signature on this form acknowledges receipt of this form. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Chayntel Hunter
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2021
LIC809 (FAS) - (06/04)
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