| · This is a single story home.
· Mandated Reporter Training expires on 3/8/27
· Pediatric CPR and First Aid Card expires on 7/2026
· Health & Safety Certificate - completed on 12/18/04
· No bodies of water at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar products must be emptied immediately after use and stored in an upright position.
· Clean, safe and age appropriate toys were present.
· Current roster on file.
· Documentation of fire and disaster drills not on file. See LIC809D.
· Children’s records are not complete.
· Employee’s records are complete.
· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
· Resident and/or staff records reviewed on 1/5/26 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.
· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov
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