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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093610094
Report Date: 10/10/2024
Date Signed: 10/10/2024 11:33:25 AM

Document Has Been Signed on 10/10/2024 11:33 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KOFF, KATHRYNFACILITY NUMBER:
093610094
ADMINISTRATOR/
DIRECTOR:
KOFF, KATHRYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 941-1199
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
10/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Kathryn KoffTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On October 10, 2024, Licensing Program Analyst (LPA) Soleil Marx met with Licensee, Kathryn Koff, for an unannounced annual inspection. During the inspection LPA observed a census of ten children in care being supervised by the licensee and assistant. All individuals subject to criminal background review have obtained a criminal record clearance. Facilities hours of operation are Monday through Friday 08:00 AM to 05:00 PM.

A health and safety inspection was conducted in the areas accessible to children. The off-limits areas include: entire upstairs, kitchen, living room with fireplace, laundry room, garage, decking off upstairs and living room. Licensee understands that children may never enter off-limit areas.

LPA observed home was safe, orderly, and free of hazards. LPA observed furniture and equipment were in good repair. LPA observed a working telephone, functioning smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher within the home. LPA observed a variety of age-appropriate toys within the home. LPA observed fireplace and stairs within the home are barricaded. LPA observed firearms within the home are properly stored and locked to meet regulation. Licensee stated there are no bodies of water on the premises. Licensee understands that if there are any poisons in the home, all poisons must be locked with a key lock or combination lock. LPA reviewed with licensee 100% supervision in unfenced areas and while utilizing balcony/decking off of the day care room.

LPA observed all required postings, a children's roster and fire drill log; the last fire drill was conducted on 06/2024. LPA reviewed records of children’s files, all which contained the required licensing forms and documentation. LPA observed infant 15 minute sleep checks are being conducted and documented. LPA reviewed records of Licensee and assistant files, both which contained the required licensing forms and documentation. LPA verified licensee and assistant have current EMSA approved pediatric CPR/First Aid training, which expires 03/2025. LPA verified licensee and assistant have current Mandated Reporter Training, which expires 09/2025. Licensee understands both CPR and mandated reporter training's’ must be completed every two years.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KOFF, KATHRYN
FACILITY NUMBER: 093610094
VISIT DATE: 10/10/2024
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LPA discussed the safe sleep regulations with licensee and the Child Care Licensing Safe Sleep webpage, https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource.

LPA informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience.

If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

The licensee, Kathryn Koff, confirmed that there are no Registered Sex Offenders living in the facility/home and LPA completed the RSO profile in FAS. .

No Title 22 deficiencies were cited based on today's inspection.

Exit interview conducted and report was reviewed with the licensee, Kathryn Koff. A notice of site visit was provided and must remain posted for 30 days.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
LIC809 (FAS) - (06/04)
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