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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624081
Report Date: 10/18/2021
Date Signed: 10/18/2021 12:01:17 PM

Document Has Been Signed on 10/18/2021 12:01 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:DYE, ASHLEYFACILITY NUMBER:
343624081
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/18/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ashley Dye - ApplicantTIME COMPLETED:
12:30 PM
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Licensing Program Analysts (LPA) Katrina Owens met with applicant for a pre licensing inspection. LPA toured the home inside and out, and reviewed forms for children's records. She understands that until a policy is obtained, she must use the affidavit.

Applicant has certificates of completion for 15 hours of health and safety training including CPR and First Aid with expiration date of 8/23/2023. All adult residents received criminal record clearances. LPA reminded applicant of the applicable Civil Penalty per person for those adults including your own child who have not received fingerprint clearances, are not associated to the license, come in contact with and or provide care and supervision to the children. LPA has provided the Applicant with the web site to enable access to all updated forms, requirements and changes. Applicant understands that she needs to notify licensing for any modification inside and out of the home. Firearms are stored according to Title 22 Regulations.

Off-limit areas include Entire upstairs, Backyard and Garage. Applicant understands that children may never enter these off-limit areas. LPA reviewed the fire drill requirements. The fire place contains a screen. 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. The backyard is fenced and there are no bodies of water. Applicant understands that 100% supervision is required in any unfenced areas. There is no pool at the home. Family pets are inaccessible to family day care children. Stairs are barricaded when children under age 5 years old are present. Planned hours of operation are Monday through Friday, 7:00 am to 5;30 pm and other hours as arranged.
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SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2021
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: DYE, ASHLEY
FACILITY NUMBER: 343624081
VISIT DATE: 10/18/2021
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LPA Owens discussed SB 277 (public health vaccination) and SB 792 (day care facilities: Immunization exemptions) with licensee at time of visit. LPA observed proof that licensee and staff/ volunteers have met the requirements of SB 792.

LPA observed that all staff has completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com.

LPA discussed the new Safe Sleep in Child Care regulation and gave licensee the brochure. LPA discussed and gave licensee the Effects of Lead Exposure brochure.

This facility is not providing Incidental Medical Services-IMS at this time. LPA discussed IMS services and the requirement to create a plan of operation. Specifics on the plan can be found in the family child care home evaluator manual (FCCH EM) Policy 102417.



LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee 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.

Effective today 10/18/2021, applicant is license 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.
Exit Interview were conducted.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021
LIC809 (FAS) - (06/04)
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