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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093615205
Report Date: 12/21/2022
Date Signed: 12/21/2022 10:51:54 AM

Document Has Been Signed on 12/21/2022 10:51 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:WATSON, STACIAFACILITY NUMBER:
093615205
ADMINISTRATOR:WATSON, STACIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 626-7162
CITY:PLACERVILLESTATE: CAZIP CODE:
95667
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
12/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Stacia WatsonTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Soleil Marx met with Stacia Watson for an unannounced annual / one year inspection. During the inspection there was a census of 11 children with the licensee and assistant. All individuals subject to criminal background review have obtained a criminal record clearance. Facilities hours of operation are 6:30 AM to 5:30 PM.

A health and safety inspection was conducted in the areas accessible to children. Off-limits areas include: master bedroom/bath, laundry room, porch, deck, carport, garage, and south side yard. Licensee understands that children may never enter these off-limits areas. The house has a working telephone, fully charged fire extinguisher, smoke detector and carbon monoxide detector that meet regulations. LPA observed all required postings. LPA advised the licensee that if there are any poisons at the home, all poisons must be locked with a key lock or combination lock. LPAs observed a fireplace/wood burning stove within the home and it is barricaded. The licensee stated that there are no firearms or bodies of water on the premises.

LPA observed a children's roster and fire drill log, the last fire drill was conducted November 2022. Licensee's has current CPR/First aid, which expires May 2023. Licensee will enroll in EMSA certified course, as the online CPR/first aid is not approved. Licensee and assistant have Mandated Reporter Training, which expired July 2022. Both licensee and assistant will renew. Licensee understands both training's must be completed every two years. LPAs observed a sample of children’s files, all which contained the required documentation. (1/2)

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2022
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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: WATSON, STACIA
FACILITY NUMBER: 093615205
VISIT DATE: 12/21/2022
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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 (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

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Licensee is aware of and practicing safe sleep regulations.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

No deficiencies were cited during today’s inspection.

Exit interview conducted and report was reviewed with the Licensee. A notice of site visit was provided and must remain posted for 30 days (2/2)

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

DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
LIC809 (FAS) - (06/04)
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