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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500263
Report Date: 03/25/2021
Date Signed: 03/25/2021 11:40:55 AM

Document Has Been Signed on 03/25/2021 11:40 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:UEBELHOER, VANDERLENEFACILITY NUMBER:
344500263
ADMINISTRATOR:VANDERLENE UEBELHOERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 385-4063
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/25/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Vanderlene UebelhoerTIME COMPLETED:
11:15 AM
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NOTE: Due to Covid-19 and DPH guidelines on physical distancing, a Tele-visit via Facetime was conducted. On Thursday, March 25, 2021, at 10:15 AM, Licensing Program Analyst (LPA) Elvira Sierra conducted an announced prelicensing tele-inspection and met with applicant, Vanderlene Uebelhoer. Applicant is applying for a License capacity of 14 children. Applicant was previously license under facility # 343620064. Fire Safety Inspection Clearance was granted on 3/8/21 for a total capacity of 14 children. Facility will operate M-F from 07:00 AM to 05:30 PM. Applicant understands that children residing in her home 10 years or younger will enter in her capacity if present. All individuals residing in the home have obtained a criminal record clearance.

At 10:20 AM, with the help of the applicant, a health and safety inspection of all areas of the home was conducted and the following was observed; The Off-limits areas will consist of; Entire upstairs, bedroom # 1 on the first floor, Garage, right and left side of the backyard, front yard, and driveway. Applicant acknowledged that children may never enter these off-limit areas. Applicant acknowledge that she is required to notify licensing prior to making changes to off-limit areas and vice versa. Safe toys and comfortable accommodations were observed. The stairs leading to the second floor is properly barricaded. Cleaning compounds, and hazardous materials are inaccessible to children. Applicant acknowledges poisons are to be locked under lock and key or combination lock while day care children are present. Home was observed having a fire extinguisher that meets Fire Marshall standards regulations. Home has a working telephone and a functional smoke and carbon monoxide detector. Fireplace in the living room area is properly barricaded. There are no bodies of water on the premises. Per applicant there are no weapons in the home. Backyard area is fenced for supervision and is equipped with age-appropriate equipment as follows: a sand box, a swing structure and a doll house. LPA observed plastic rubber bark under the play structure. Applicant was advised to maintain bark for cushioning specially around and under play equipment, and to cover sand box when not in use to prevent water from accumulating in the sandbox. Clean the sand regularly making sure is free of any foreign objects or debris.

Day-care children may never be left alone with minors and adults providing care and supervision are to obtain criminal record clearances prior to working or living in the home. Applicant stated that she won't be transporting children. Applicant owns the home and applicant submitted a copy of home mortgage statement to show control of property. Applicant did not obtain liability insurance of $300,000 and is aware that the liability affidavit must be signed by all parents of enrolled children.

----Report continues on subsequent page 809C---

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 03/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2021
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: UEBELHOER, VANDERLENE
FACILITY NUMBER: 344500263
VISIT DATE: 03/25/2021
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LPA advised applicant that baby walkers, bouncers, jumpers, and similar items are not allowed in a Family Child Care Home. It was discussed that fire drills must be conducted and documented at least every six months; LPA provided applicant with a Fire Drill log. Aplicant's CPR expires on 06/2022. Mandated child abuse training expires on 01/03/3023. LPA explained that child abuse training must be renew every two years (AB1207).

LPA discussed the smoking prohibition with the Applicant. Incidental Medical Services (IMS) policy was discussed. 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


LPA discussed supervision, personal rights, criminal record clearances, staffing ratios and capacity, and maintaining buildings and grounds. Applicant was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes. LPA provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochures. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so applicant can request to be added to the distribution list to receive Quarterly Updates.*LPA discussed guidance and practices regarding social and physical distancing for providers to prevent exposure to COVID-19 while providing care for children. COVID-19 Posting documents and the use of Personal Protective Equipment during COVID-19 Outbreak.

As of today's date, facility is licensed to serve 12 children (when there is an assistant present) with no more than 4 infants, or capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or elementary school and 1 child at least age 6 with a maximum of 3 infants. In lieu of applicant's signature, LPA is e-mailing the report with a read receipt request to applicant. Please note: When a physical inspection takes place, requests for alterations may be made

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021
LIC809 (FAS) - (06/04)
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