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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620693
Report Date: 10/22/2024
Date Signed: 10/22/2024 01:52:05 PM

Document Has Been Signed on 10/22/2024 01:52 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:COSTA, CRISTINAFACILITY NUMBER:
313620693
ADMINISTRATOR/
DIRECTOR:		COSTA, CRISTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 488-6233
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
10/22/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Cristina CostaTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On October 22, 2024 at approximately 11 AM Licensing Program Analyst (LPA) Michelle Perez met with Licensee, Cristina Costa, for an unannounced one year inspection. During the inspection there was a census of 11 CHILDREN (four infants and seven preschoolers) supervised by the licensee and an assistant. All individuals subject to criminal background review have obtained a criminal record clearance. Facilities hours of operation are Monday through Friday 6am to 6pm.

A health and safety inspection was conducted in the areas accessible to children. The off-limit areas are include: Master bed/bath, kitchen, backyard and garage. During today's visit, licensee requested daughter's room to be on limits. Effective today, the room is now on-limits. 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 observed home was safe, orderly, and free of hazards. 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. LPA observed wood burning stove within the home that is barricaded. The licensee stated that there are no firearms or bodies of water on the premises.

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
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: COSTA, CRISTINA
FACILITY NUMBER: 313620693
VISIT DATE: 10/22/2024
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LPA observed a children's roster and fire drill log, the last fire drill was conducted September 2024. Licensee's has current CPR/First aid, which expires 9/2026. Licensee and staff's Mandated Reporter Training expires July 2026 and September 2026. Licensee understands both training’s must be completed every two years. LPAs reviewed records of children’s files, all which contained the required documentation.

Incidental Medical Services (IMS) policy was discussed and not currently provided. 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 safe sleep regulations and practicing them. LPA verified infant sleep logs.

No deficiencies were cited during today’s inspection.

Exit interview conducted and report was reviewed with the Licensee, Cristina Costa. A notice of site visit was provided and must remain posted for 30 days

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC809 (FAS) - (06/04)
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