313625165-8-9-2023-03-CC-LHAM-CUJNKJ-20230809103202

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313625165
Report Date: 08/09/2023
Date Signed: 08/09/2023 10:32:19 AM

Document Has Been Signed on 08/09/2023 10:32 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:	LICATA, PAUL		FACILITY NUMBER:	313625165
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	08/09/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Paul Licata		TIME COMPLETED:	10:40 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On August 9, 2023, Licensing Program Analyst (LPA) Lea Habtom met with applicant, Paul Licata, for a scheduled Pre- Licensing inspection, this is a change of location. Applicant was previously licensed under facility #313624018. Applicant is the owner of the home. LPA and applicant toured the entire home inside and out. Applicant resides in a single story home consisting of three bedrooms, two bathrooms, a living room, a dining room, a kitchen, a garage, and a fenced backyard. Children forms were not reviewed as applicant recently had an annual inspection with LPA Lea Habtom who verified that applicant has all forms necessary. Applicant has obtained liability insurance of up to $300,000. Applicant’s hours of operation are Monday-Friday from 7:30 am- 4:30 pm other hours as arranged. Applicant agrees to notify licensing if her days of operation will change or another job is obtained. Applicant completed the Preventative Health and Safety course on July 17, 2021. Applicant has certificates of completion for 16 hours of health and safety training including CPR and First Aid with expiration date of 7/2025. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Applicant 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. Off-limit areas includes: the shed. Applicant understands that children may never enter these off-limit areas. Applicant understands that she needs to notify licensing for any modification inside and out of the home. Report continued on 809-C

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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: LICATA, PAUL	FACILITY NUMBER: 313625165
	VISIT DATE: 08/09/2023

NARRATIVE

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LPA reviewed the requirement of maintaining a fire drill log and a children’s roster. There is no fireplace and stairs in the home. There are no weapons in the home. Fire extinguisher, carbon monoxide detector and smoke detectors meet regulation. Hazardous cleaning compounds are inaccessible to children.
Sharp utensils and medications are inaccessible to children. . Applicant understands that 100% supervision is required in any unfenced areas.

The backyard is fenced and there are no bodies of water.

LPA Washington discussed SB277 (public health vaccination) and SB792 (day care facilities: Immunization exemptions) with Applicant at time of inspection. Applicant has met the requirements of SB792 and her vaccination record is in the RO file.

LPA observed that applicant has completed the required mandated reporter training with an expiration date of 6/29/2025 (AB1207) at website: www.mandatedreporterca.com.

Applicant does not plan on offering infant care.

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: http://www.ada.gov/childqanda.htm

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the Applicant can obtain updated licensing information, new regulations and access forms. LPA advised Applicant of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

Report continued on 809-C

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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: LICATA, PAUL	FACILITY NUMBER: 313625165
	VISIT DATE: 08/09/2023

NARRATIVE

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LPA reviewed with applicant Paul Licata, the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted and provided copies of all forms.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed- related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Effective today August 9, 2023, applicant is licensed to serve up to either 8 children, two (2) of which must be at least 6 years of age and no more than two (2) may be infants; or 6 children, three (3) of which may be infants; or 4 infants only. Infants are children under the age of 2 years.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC809 (FAS) - (06/04)

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