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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093623154
Report Date: 07/13/2023
Date Signed: 07/13/2023 01:51:32 PM

Document Has Been Signed on 07/13/2023 01:51 PM - 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:EWING, SALLY & DONALDFACILITY NUMBER:
093623154
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
07/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Sally EwingTIME COMPLETED:
02:15 PM
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On July 13th, 2023, Licensing Program Analyst (LPA) Soleil Marx met with Licensee's, Sally and Donald Ewing, for an unannounced annual / one year inspection. During the inspection there was a census of 8 children in care being supervised by the licensee's. All individuals subject to criminal background review have obtained a criminal record clearance. Facilities hours of operation are Monday through Friday 07:30 AM to 05:30 PM.

A health and safety inspection was conducted in the areas accessible to children. The off-limits areas include: all bedrooms, closet by hallway, laundry room, garage and front yard. Licensee understands that children may never enter these off-limits areas.

LPA observed a working telephone, functioning smoke and carbon monoxide detector, and a 2A10BC fire extinguisher within the home. LPA observed home was safe, orderly, and free of hazards. LPA observed a variety of age-appropriate toys within the home. LPA observed fireplace within the home was properly barricaded to meet regulations. Licensee stated there are no firearms or 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 observed all required postings, a children's roster and fire drill log, the last fire drill was conducted 05/2023. LPA reviewed records of children’s files and staff files, all which contained the required documentation. Licensee's have current EMSA approved pediatric CPR/First Aid training, which expires 08/2023. Licensee's have current Mandated Reporter Training, which expires 06/2024. Licensee's understand 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: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023
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: EWING, SALLY & DONALD
FACILITY NUMBER: 093623154
VISIT DATE: 07/13/2023
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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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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 informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

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

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
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: EWING, SALLY & DONALD
FACILITY NUMBER: 093623154
VISIT DATE: 07/13/2023
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 LPA observed during inspection eight children in care, three of whom were infants, which exceed the conditions, limitations and capacity specified on the license.

Based on Today’s inspection, Deficiencies are being cited on 809-D.

The Licensee's were informed that this report dated 07/13/2023 documents one Type A citation which shall be posted for 30 consecutive days. The Licensee shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Licensee has been provided with appeal rights.

During the exit interview, the licensee, Sally and Donald Ewing, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the licensee, Sally and Donald Ewing. A notice of site visit was given and must remain posted for 30 days.

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

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/13/2023 01:51 PM - It Cannot Be Edited


Created By: Soleil Marx On 07/13/2023 at 01:28 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: EWING, SALLY & DONALD
FACILITY NUMBER: 093623154

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1597.44(b)
Health and Safety Code section 1597.44 states:
A small family day care home may provide care for more than six and up to eight children, without an additional adult attendant, if all of the following conditions are met:
(b) No more than two infants are cared for during any time when more than six children are cared for.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above by having 3 infants with 8 children in care, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/14/2023
Plan of Correction
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LPA Marx provided licensee's with regulations and resources regarding Small Family Child Care Home ratio and capacity, and will return to observe proper ratio and capacity.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Natalie Dunaway
LICENSING EVALUATOR NAME:Soleil Marx
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2023


LIC809 (FAS) - (06/04)
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