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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313617082
Report Date: 02/06/2025
Date Signed: 02/06/2025 11:51:00 AM

Document Has Been Signed on 02/06/2025 11:51 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LAKE, AKIKOFACILITY NUMBER:
313617082
ADMINISTRATOR/
DIRECTOR:		LAKE, AKIKOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 316-1523
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
02/06/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Akiko LakeTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On Thursday, February 6, 2025, Licensing Program Analyst (LPA) Lea Habtom met with Licensee, Akiko Lake, for the purpose of an unannounced annual inspection. Upon arrival, LPA observed licensee and her assistant supervising 12 children consisting of 4 infants and 8 preschool children. Licensee's spouse, adult son & adult daughter were present in the home. Licensee's daughter was present with her two children, infant & preschool, who were not counted in ratio. All individuals subject to criminal background review have obtained a criminal record clearance. Licensee confirmed that there are no new residents or employees since the last inspection. LPA observed proper ratio and capacity was being followed. Facility hours of operation are Monday through Friday from 7:00 AM to 5:30 PM.

A health and safety evaluation was conducted in all areas accessible to children. Off-limit areas include: entire upstairs, garage and laundry room. Licensee acknowledged that children may never enter these off-limit areas. LPA observed that the facility is clean, safe, sanitary, and in good repair. LPA observed a functioning smoke detector, carbon monoxide detector, and a full 2A10BC fire extinguisher. The facility has adequate toys that appear to be safe for children to use. The weapon and ammunition were locked and stored separately. LPA observed a fireplace barricaded according to regulation. The backyard is fenced and there are no bodies of water. The stairs is fenced to prevent access to children under the age of 5 years.

LPA reviewed children’s files. Required postings and the children’s roster were observed. Licensee has infants enrolled. Licensee last conducted a fire drill on 9/5/2024. Licensee’s CPR/First Aid card expires 1/19/2026. Licensee’s Mandated Reporter certificate expires 10/9/2026. Licensee understands that trainings must be completed every two years.

LPA verified that the annual fees are current. 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.

PAGE 1. REPORT CONTINUES ON LIC809-C
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: LAKE, AKIKO
FACILITY NUMBER: 313617082
VISIT DATE: 02/06/2025
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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-and-resources/safe-sleep as an additional resource. LPA also 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.

Licensee understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. Licensee understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report/LIC 624 shall be submitted within 7 days to remain in compliance. Licensee understands that if any structural changes are made to the home; licensing must be notified PRIOR to construction. Licensee understands that if she wants to make any changes to OFF-limit areas to an ON-limit area, she must notify licensing and LPA must do an inspection BEFORE children are allowed in said area. Licensee understands that children’s records are to be maintained according to Title 22 regulations and be accessible to licensing for up to 3 years.

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.

Page 2. REPORT CONTINUES ON LIC809C
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
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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: LAKE, AKIKO
FACILITY NUMBER: 313617082
VISIT DATE: 02/06/2025
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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.

A notice of site visit was given and must remain posted for 30 days. Appeal rights provided. Based on the inspection, one Type B citation has been issued. Exit interview conducted and report was reviewed with the licensee Akiko Lake. During the exit interview, the Licensee Akiko Lake, confirmed that there are no Registered Sex Offenders living in the home.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
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Document Has Been Signed on 02/06/2025 11:51 AM - It Cannot Be Edited


Created By: Lea Habtom On 02/06/2025 at 11:39 AM
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: LAKE, AKIKO
FACILITY NUMBER: 313617082

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that the licensee did not document sleep checks and did not complete sleep plans for infants under 12 months which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/06/2025
Plan of Correction
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Licensee agreed to email LPA L. Habtom a sample of sleep checks and the sleep plans by plan of correction date of 3/6/2025.
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:Mai Lor
LICENSING EVALUATOR NAME:Lea Habtom
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2025


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