Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618611
Report Date: 11/03/2016
Date Signed 11/03/2016 12:47:44 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:SCHWARZ, SUZANNFACILITY NUMBER:
343618611
ADMINISTRATOR:SCHWARZ, SUZANNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 910-9491
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY:14CENSUS: 10DATE:
11/03/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Suzann SchwarzTIME COMPLETED:
01:10 PM
NARRATIVE
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LPA Washington met with licensee Suzann Schwarz for the purpose of an annual random visit. All individuals subject to criminal background review have obtained a criminal record clearance. During the visit LPA observed 4 infants and 6 preschool children supervised by Licensee and her Assistant Desirae.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include the master bedroom/bathroom, garage, laundry room, and the right side of the yard. LPA observed a working phone, 2A10BC fire extinguisher, first aid kit and functioning smoke and carbon monoxide detectors. Per licensee, there are no weapons in the home. No children were observed in parked cars. There are no accessible bodies of water on the premises. Toxic and hazardous items are inaccessible to children. Safe toys and comfortable accommodations were observed. The fireplace located in the dining room is appropriately barricaded to prevent access by children. There are no stairs in the home.

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. Updated immunization requirements were discussed.

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2016
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: SCHWARZ, SUZANN
FACILITY NUMBER: 343618611
VISIT DATE: 11/03/2016
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Children's and facility records were reviewed. Emergency information was observed in each child's file. Preventative health training, current pediatric CPR and first aid certification was verified and expires 04/24/2017. A current roster and disaster drill log are being maintained.

This facility evaluation report was reviewed and discussed with the licensee. A notice of site visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of 3 years for public review upon request.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2016
LIC809 (FAS) - (06/04)
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