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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622567
Report Date: 07/22/2022
Date Signed: 07/22/2022 12:24:35 PM

Document Has Been Signed on 07/22/2022 12:24 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:PETTY, KARENFACILITY NUMBER:
343622567
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/22/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Karen PettyTIME COMPLETED:
12:40 PM
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On July 22, 2022 around 11:00 am, Licensing Program Analyst (LPA) Lea Habtom met with Licensee Karen Petty for the purpose of an unannounced case management inspection. Licensee has requested to increase from a small family childcare to a large family childcare. The facility was granted a fire clearance on July 11, 2022 by Sacramento Metropolitan Fire Department.

During today’s inspection, Licensee was the only person present in home during the inspection. All individuals subject to criminal background review have obtained a criminal record clearance. LPA verified with Licensee that her current associations are accurate.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas will remain the same, which is: the main home. Day care is operating in the back cottage. Licensee agrees and understands that children may never have access to any off limit areas of the home. Licensee acknowledges that she must contact Community Care Licensing prior to making an off-limit area on-limits and vice versa.

LPA discussed ratios for a large capacity and personnel records. Licensee understands that related children and own children under the age of 10 count towards the total ratio and capacity. LPA discussed required documentation for adult and minor assistants.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Report continued on 809-C
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2022
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: PETTY, KAREN
FACILITY NUMBER: 343622567
VISIT DATE: 07/22/2022
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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.

In the areas that were evaluated, no deficiencies were observed at the time of the inspection.

Effective today, July 22, 2022, Licensee’s request for a Large Family Child Care License is approved. Licensee can now provide care for 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of two years. Licensee understands that when there is no assistant present, ratios of a small capacity must be adhered to.

Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for childcare updates, current forms, legislation and regulation information. This facility evaluation report was reviewed and discussed with the licensee.

An exit Interview was conducted, and a Notice of Site Visit was provided, which should remain posted for 30 days for parental review.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC809 (FAS) - (06/04)
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