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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 255408012
Report Date: 11/17/2021
Date Signed: 11/18/2021 10:50:54 AM

Document Has Been Signed on 11/18/2021 10:50 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:HARER, SAMANTHA FAMILY CHILD CARE HOMEFACILITY NUMBER:
255408012
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/17/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Samantha HarerTIME COMPLETED:
12:15 PM
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A pre-licensing inspection was conducted today by Licensing Program Analyst (LPA) N. Cunningham. Applicant Samantha Harer is requesting a license for a capacity of eight children with services available Monday through Friday, 07:00am – 07:00pm, year round. Parents and children will enter the facility using the door by the front porch. Applicant stated they understand consecutive, 24-hour care is prohibited and that childcare must be provided in the "primary" residence of the applicant's home. There are currently two adults living in the home. Applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. All minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday. The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance.

LPA consulted on COVID-19 guidelines and reporting requirements which consisted of social distancing, facial covering, conducting visual well-ness checks, temperature screening, hand washing for a minimum of 20 seconds, and reporting positive cases or exposures to public health and CCL.

The residence is a two bedroom, two bathroom, one story home. Children in care will have access to the living room, kitchen, dining room, playroom, and bathroom. The "off limits" areas include the two bedrooms and master bathroom. These areas were observed to be made inaccessible by a child gate. There is no trampoline on the property, however, the applicant plans on installing one a considerable distance from the FCCH and it will not be for day care use. The applicant understands if the trampoline is used during day care hours, it must be used according to the manufacturer’s recommended usage. Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. Proof of control of property is on file. The home appears to be clean and orderly at this time, and applicant stated it will remain so during child care hours. There is a working telephone in the home. The sharp knives, cleaning supplies, medications, and other potential hazards are stored out of the reach of children.



Continued on LIC 809-C
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2021
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: HARER, SAMANTHA FAMILY CHILD CARE HOME
FACILITY NUMBER: 255408012
VISIT DATE: 11/17/2021
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Applicant stated that there are no firearms or other weapons stored on the premises and none were observed during today's visit. Applicant stated poisons are stored in a shed which is locked with a key lock. There is no pool, pond, hot tub, fountain, creek, or other body of water on the property. The children will use the front yard as the outdoor play area which is not fenced. The applicant understands that constant supervision is required when the outdoor play area is not fenced.

Incidental Medical Services (IMS) regulations were reviewed with applicant. Applicant stated they understand that, if IMS are provided, an updated Plan of Operation shall be submitted and on file with the Department. Applicant was advised Parent's Rights poster and other required postings must remain posted throughout licensure, emergency drills must be conducted and documented at least once every six months. Children's records to be maintained were reviewed. Applicant stated they understand the roster is to remain current at all times. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days. Applicant stated they will maintain current pediatric CPR and First Aid certification, as well as Mandated Reporter Training certification. Applicant stated they shall be present in and reside in the home and shall ensure that children in care are supervised by a fingerprinted adult with current pediatric CPR and First Aid certification. Applicant understands that children may only be transported safely by adults with a criminal record clearance and are never to be left unattended in a vehicle. Applicant understands infants and children shall not be allowed to sleep in car carriers in the home. Applicant stated they clearly understand the maximum number of children for whom care can be provided, the limitations on the number of infants (birth to age 2) that may be cared for, and when two of the children in care must be school aged. Applicant stated they understand the responsibility to read and have knowledge of the laws and regulations for operation of a family child care home and that forms and regulations may be obtained from the website: http://ccld.ca.gov/.

Megan's Law web site information was provided: http://www.meganslaw.ca.gov. The AAP Guide to Safe Sleep Practices and the Effects of Lead Exposure brochures were provided and reviewed with Applicant. Applicant stated they understand that any authorized employee of the Department may enter and inspect the facility with or without advance notice. Applicant stated they understand that any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

This facility meets licensing standards and is licensed as a Small Family Child Care Home as of 11/18/2020.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021
LIC809 (FAS) - (06/04)
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