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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618170
Report Date: 09/26/2022
Date Signed: 09/26/2022 12:53:36 PM

Document Has Been Signed on 09/26/2022 12:53 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:GOVER, ROBYNFACILITY NUMBER:
343618170
ADMINISTRATOR:GOVER, ROBYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 607-3907
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
09/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Robyn GoverTIME COMPLETED:
01:15 PM
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On Monday, September 26th, 2022, Licensing Program Analysts (LPAs) Kelly Ferrara and Soleil Marx conducted an unannounced annual inspection and met with Licensee Robyn Gover. LPAs observed there were currently 12 children in care with the Licensee and an assistant. Facility hours of operation are Monday through Friday 7:30 AM to 5:30 PM. LPAs observed that the Licensing annual fees are current.

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.

Off limit areas include: Entire upstairs, master bathroom, third car garage and left side yard. Licensee acknowledged that children may never enter these off-limit areas. LPAs conducted a health and safety inspection and observed that the facility is clean, safe, sanitary, and in good repair with proper ventilation. LPAs observed the proper documents were posted where visible to parents. LPAs observed that the cleaning compounds, medications, and sharp objects were kept inaccessible to children. LPAs observed a 2A-10-BC fire extinguisher which is accessible. LPAs observed the smoke and carbon monoxide detectors are functioning properly. The facility has adequate toys that are safe for children to use. The backyard is fenced and LPAs observed the pool was fenced and gated according to regulations. LPAs observed the firearms and ammunition were stored according to regulations.

LPAs observed a current children's roster and fire drill log. LPAs reviewed children’s files and observed that all the required documentation was present in each child's file. LPAs observed the CPR/1st aide certificate was current and expires February 2024. LPAs observed a current Mandated Reporter certificate for the Licensee and Licensee was reminded the Child Care portion must be completed every two years. LPAs observed the assistant had all of the required documentation in their file.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2022
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: GOVER, ROBYN
FACILITY NUMBER: 343618170
VISIT DATE: 09/26/2022
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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.

Incidental Medical Services- IMS policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 discussed current COVID guidelines with Licensee and provided technical assistance.

LPAs provided the Department’s website WWW.CCLD.CA.GOV, so the Licensee can obtain updated licensing information, new regulations and access forms. LPAs advised Licensee of their responsibility to stay current by reviewing PINs on the website.

There were no citations issued based on today's inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with the Licensee.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC809 (FAS) - (06/04)
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