444416835-9-21-2023-07-CC-CNEN-CVVUEK-20230921153115

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444416835
Report Date: 09/21/2023
Date Signed: 09/21/2023 03:31:21 PM

Document Has Been Signed on 09/21/2023 03:31 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	LOTZ, SUSAN		FACILITY NUMBER:	444416835
ADMINISTRATOR:	LOTZ, SUSAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 252-9230
CITY:	BEN LOMOND	STATE: CA	ZIP CODE:	95005
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/21/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Sue Lotz		TIME COMPLETED:	03:41 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Cortney Nelson, met with Applicant, Sue Lotz, for pre-licensing inspection to ensure home is in compliance with Title 22 California Code of Regulations. Upon arrival, LPA was admitted by the Applicant and toured inside and outside of the family child care home (FCCH). The Applicant states that additional adult, over the age of 18, residing in the home is her spouse, Fred Lotz. The hours of operation for the FCCH will be Monday-Friday 9:00AM-1:00PM and plans to enroll children ages 2-5. The Applicant states she is not planning to work with any food programs. The Applicant provided proof of control of property and is planning to obtain liability insurance for the day care. LPA advised Applicant to complete Affidavit Regarding Liability Insurance (LIC282) with enrolled families if she does not obtain liability insurance or chooses not to renew in the future. The Applicant 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated. LPA toured the property and observed that there are three buildings: the Applicants home, the day care building, and a storage/laundry room. The Applicants home and storage/laundry room are entirely off-limits. The day care building does not have any off-limits areas. The day care building is orderly and safe for day care children. There is central heating and the Applicant states she has a portable AC unit that can be used during hot weather. There is a working phone (cellphone) at the facility. The Applicant states that there are no weapons or firearms in the home. The Applicant states that the day care will provide potty training for children who need it.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LOTZ, SUSAN	FACILITY NUMBER: 444416835
	VISIT DATE: 09/21/2023

NARRATIVE

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Outdoor areas of the home were inspected today and observed to be fenced in. There are a variety activities for the children to play with, such as a playground structure, bikes, large grass yard, garden boxes, and sitting area. There are additionally two goats and one chicken that are caged and friendly. Off-limits outside of the home include detached garage area, driveway, and all other areas outside of fenced area for children. No outdoor bodies of water were observed during todays inspection.

LPA observed two 2A10BC fire extinguishers, working smoke detector and carbon monoxide detector. A fire clearance was approved by Ben Lomond Fire Department on 8/28/2023. The Applicant was advised that emergency/disaster drills shall be completed every six months. All cleaning compounds, poisons, medications, and other similar items are stored inaccessible to children. The Applicant states that she will administer medication for children as needed. LPA advised the Applicant to complete Parent Consent for Administration of Medications and Medication Chart (LIC9221) and discussed proper storage for medication.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (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.

Applicant states that for discipline of the children, she will use redirection and have the children take breaks as needed. LPA advised Applicant that if utilized, recommended duration for "time out" is 1 minute per year of age for the child. The Applicant understands that children's personal rights should not be violated; including no corporal punishment. Children should not be left for extended periods of time in furniture such as a high chair or play pen. LPA discussed isolation of sick children with applicant, supervision of children, transporting children, unusual incidents (LIC624B), reporting suspected child abuse, and requirements for additional staff/ adults living in the home.

LPA reviewed with Applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LOTZ, SUSAN	FACILITY NUMBER: 444416835
	VISIT DATE: 09/21/2023

NARRATIVE

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102416.5 Staffing Ratio and Capacity was discussed with the Applicant and she understands that the maximum number of children that may be cared for, when there is a provider assistant is present in the home, shall be twelve (12) children, with no more than four (4) infants, or up to fourteen (14) children where at least one child is enrolled in or attending kindergarten or elementary school and the second child is at least six years old. LPA advised that when an assistant provider is not present, the Applicant shall follow capacity requirements for a small family child care home. LPA additionally advised that any children living in the home will be counted in ratio until they turn ten (10) years of age.

LPA discussed the safe sleep regulations with Applicant and provided 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 Applicant 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.

On this date, 8/11/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit interview conducted and report was reviewed with the Applicant, Sue Lotz.

LPA advised applicant that a large family day care license will be issued pending manager review.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC809 (FAS) - (06/04)

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