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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093605882
Report Date: 02/11/2022
Date Signed: 02/15/2022 10:25:42 AM

Document Has Been Signed on 02/15/2022 10:25 AM - It Cannot Be Edited

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:KERSEY, CINDYFACILITY NUMBER:
093605882
ADMINISTRATOR:KERSEY, CINDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 337-9482
CITY:CAMERON PARKSTATE: CAZIP CODE:
95682
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
02/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Cindy KerseyTIME COMPLETED:
10:35 AM
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On 2/15/22 at 9:20AM, a required inspection was made to the facility by Licensing Program Analyst (LPA) Mikah Martinez. A review of staff records on 2/8/22 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 currently two adults living in the home. At 10:10AM the home was toured inside and outside. The licensee and a minor assistant were supervising 10 children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 9-12, Tuesday and Thursday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the entire home except for the restroom, living room for access to the bathroom and the sun room. Poisons are locked in the top shelf of the kitchen which children do not enter. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. The fireplace is not used . There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are firearms in the home however they are locked and stored away from the day care area and stored appropriately. The home is clean, orderly and comfortable. Stairs are inaccessible. There are safe toys and equipment available for children. There is a working telephone in the home. The children use the back yard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed in the yard. Ten children's records were reviewed at 9:40AM; required emergency information forms were observed to be on file. Individual Sleeping Plans were on file for infants under 12 months of age. The licensee has completed Mandated Reporter training. The licensee and all employees have the required immunization's on file. The licensee has current pediatric CPR and First Aid certification, which expire on 8/2023. This report was 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.
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Mikah Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2022
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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