Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313619903
Report Date: 07/11/2017
Date Signed 07/11/2017 12:20:33 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:GRIFFIN, JENNIFERFACILITY NUMBER:
313619903
ADMINISTRATOR:GRIFFIN, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 790-9490
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:14CENSUS: 10DATE:
07/11/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Jennifer GriffinTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Amie Randa met with licensee Jennifer Griffin for an unannounced annual inspection. The facility operations Monday-Thursday from 7:00am-5:00pm. LPA toured all areas of the home that are accessible to the children and observed care and supervision, a current roster of children, capacity and ratio. Today’s census was ten children; three of which were under the age of two years.. Also present in the home was the licensee's assistant who has been fingerprint cleared. LPA confirmed that all adult residents residing or working in the home have criminal record clearances. LPA advised licensee if anyone over the age of 18 years old moves into the home they must have a criminal record clearance as well. LPA observed posting of the license, Parent's Rights and the current disaster plan.

Off-limit areas include Master bedroom, back deck, garage and downstairs bathroom. Licensee acknowledged that children may never enter these off-limit areas. The backyard is fenced and licensee acknowledges that children may never be left unsupervised in an unfenced area of the yard. LPA observed that the licensee had stairs barricaded. There are no bodies of water on the property and licensee stated there are no weapons in the home.

LPA observed current CPR and First Aid certificates that expires on 01/2018. LPA observed that poisons are locked and that fire extinguisher, smoke detector and carbon monoxide detector meets regulation. Fireplace is inoperable, cleaning materials, hazardous items and medications are all inaccessible to children. LPA observed a Fire Drill Log and the licensee is conducting fire drills at least every six months. There is a working telephone, toys appear to be in a safe condition and the home appears to be clean and orderly.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms.
SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Amie RandaTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2017
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: GRIFFIN, JENNIFER
FACILITY NUMBER: 313619903
VISIT DATE: 07/11/2017
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LPA observed that infants sleep in porta-cribs located in a downstairs bedroom and the older children sleep on mats in the living room. LPA discussed SIDS and the licensee stated Safe Sleep Practices are understood.

LPA discussed the new Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care facility must have vaccinations against, Pertussis, Influenza and Measles. LPA conducted file reviews and observed that all staff are in compliance in regards to Immunization Regulation, LPA observed proof that staff have been vaccinated against Measles, Pertussis and Influenza.

LPA also discussed the new smoking regulation (AB 1819-Smoking Prohibition) and the new Incidental Medical Services (IMS) policies with the licensee. 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

No Title 22 Deficiencies were observed in the areas that were evaluated. LPA read this report to the licensee; she stated that understands today’s inspection. Appeal Rights were provided, Notice of Site Visit posted and the licensee understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Amie RandaTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2017
LIC809 (FAS) - (06/04)
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