Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455406533
Report Date: 11/30/2017
Date Signed 11/30/2017 12:33:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:LACK, KIMBERLY FAMILY CHILD CARE HOMEFACILITY NUMBER:
455406533
ADMINISTRATOR:LACK, KIMBERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 510-1928
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY:14CENSUS: 12DATE:
11/30/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Kimberly LackTIME COMPLETED:
12:40 PM
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An inspection was made to the facility by LPA Patricia Pacheco. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are presently 2 adults and 1 minor living in the home.

During today’s inspection the home and grounds were toured. The licensee was properly supervising children and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. Operating hours are 7:30 am to 5:30 pm, Monday –Friday. The floor plan was verified. Day care is primarily provided in the detached day care room that is equipped with a kitchenette and bathroom. The off-limits areas were inaccessible by means of gates. The home appeared clean and orderly and was at a comfortable indoor temperature. There were safe toys and equipment available for children. There is a working telephone in the home. The licensee's pediatric CPR and First Aid expire 12/31/17. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) were stored out of the reach of children. Poisons are locked in the detached shed. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee has a current roster of children in care and has conducted an emergency drill within the past six months. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection. The children use the backyard as the outdoor play area and it is fully fenced. There were no bodies of water observed. Children's records were reviewed; current immunization records and Notification of Parent’s Rights forms were on file. The licensee is not currently providing Incidental Medical Services – IMS. 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 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,www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices brochure, were reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years. There were no Title 22 deficiencies cited during today's inspection
Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Patricia PachecoTELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2017
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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