Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622321
Report Date: 03/06/2018
Date Signed 03/06/2018 09:47:53 AM

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:BAGGS, AUDREYFACILITY NUMBER:
343622321
ADMINISTRATOR:BAGGS, AUDREYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 228-4865
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:14CENSUS: 0DATE:
03/06/2018
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Audrey Baggs - ApplicantTIME COMPLETED:
10:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPA) Owens met with applicant for a pre licensing, change of location, inspection. LPA toured the home inside and out. LPA explained about obtaining $300,000 liability insurance. Applicant has a liability policy.
Applicant has certificates of completion for 15 hours of health and safety training including CPR and First Aid with expiration date of 7/26/18. All adult residents received criminal record clearances. LPA reminded applicant of the applicable Civil Penalty per person for those adults including your own child who have not received fingerprint clearances, are not associated to the license, come in contact with and or provide care and supervision to the children. LPA has provided the Applicant with the web site to enable access to all updated forms, requirements and changes. Applicant understands that she needs to notify licensing for any modification inside and out of the home. Applicant received an approved fire clearance on 2/28/18. Fire clearance stated no day care children shall be in the garage or upstairs of home.
Off-limit areas include Entire upstairs, Downstairs office, Laundry Room and Garage. Applicant understands that children may never enter these off-limit areas. LPA reviewed the fire drill requirements. The fire place contains a screen. Applicant stated there are no weapons in the home. Fire extinguisher, carbon monoxide detector and smoke detectors meet regulation. Hazardous cleaning compounds are inaccessible to children. Sharp utensils and Medications are inaccessible to children. The backyard is fenced and there are no bodies of water. Applicant understands that 100% supervision is required in any unfenced areas. There is no pool at the home. The licensee has three cats and she chooses to allow the cats to have access to day care children and she is aware that she is responsible for child safety around pets at all times. Stairs are barricaded when children under age 5 years old are present. Planned hours of operation are Monday through Friday, 7:30 am to 4:30 pm and other hours as arranged. Applicant does not transport children.
LPA Owens discussed SB 277 (public health vaccination) and SB 792 (day care facilities: Immunization exemptions) with licensee at time of visit. LPA observed proof that licensee and staff/ volunteers have met the requirements of SB 792.

LPA observed that all staff has completed the required mandated reporter training at website: www.mandatedreporterca.com.

See page 2.

SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2018
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: BAGGS, AUDREY
FACILITY NUMBER: 343622321
VISIT DATE: 03/06/2018
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Incidental Medical Services (IMS) policy was discussed. Applicant stated IMS is not being provided at this time. 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

Effective today 3/6/2018 applicant is a license to serve up to either 14 children, (WHEN THERE IS AN ASSISTANT PRESENT), 12 children -No more than 4 infants. Capacity 14 - No more than 3 infants. 1 Child in Kindergarten or Elementary school and 1 child at least age 6.
SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2018
LIC809 (FAS) - (06/04)
Page: 2 of 2