Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 535406471
Report Date: 11/13/2017
Date Signed 11/13/2017 10:27:41 AM

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:INGRAM, REBECCA FAMILY CHILD CARE HOMEFACILITY NUMBER:
535406471
ADMINISTRATOR:INGRAM, REBECCAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 680-9626
CITY:WEAVERVILLESTATE: CAZIP CODE:
96093
CAPACITY:14CENSUS: 5DATE:
11/13/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Rebecca IngramTIME COMPLETED:
10:30 AM
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An annual random inspection was made to the facility by LPA, Sandy Husband. 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 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 5:00 PM, Mon–Fri. The floor plan was verified. The off-limits areas (upstairs with a gate at the bottom of the staircase, the living room, front bedroom and front bathroom which were gated and/or contained a door knob cover) were inaccessible.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 8/31/19. 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 a detached shop. The staircase is barricaded. The fireplace has a secured screen. There is a working smoke detector, carbon monoxide detector and charged 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. The swing set and play have sufficient cushioning to absorb falls. There were no bodies of water observed. Children's records were reviewed; current immunizations and Notification of Parent’s Rights forms were on file.
(Continued on LIC 809-C)


SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sandra HusbandTELEPHONE: 530-895-5913
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2017
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: INGRAM, REBECCA FAMILY CHILD CARE HOME
FACILITY NUMBER: 535406471
VISIT DATE: 11/13/2017
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(Continued from LIC 809)
The licensee is not 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.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sandra HusbandTELEPHONE: 530-895-5913
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2017
LIC809 (FAS) - (06/04)
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