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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500012
Report Date: 06/24/2021
Date Signed: 06/24/2021 10:40:47 AM

Document Has Been Signed on 06/24/2021 10:40 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:ROGERS, LORIFACILITY NUMBER:
574500012
ADMINISTRATOR:ROGERS, LORIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 908-7074
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 8DATE:
06/24/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee, Lori RogersTIME COMPLETED:
10:50 AM
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On June 24, 2021, Licensing Program Analyst (LPA) Chayntel Hunter met with Licensee, Lori Rogers for the purpose of an unannounced annual inspection. All individuals subject to criminal background review have obtained a criminal record clearance. There were eight children present at the time of inspection. Licensee's husband/assistant was also present during the inspection. Licensee's operating hours are Monday through Friday from 7:30 AM. to 5:30 PM.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include all the bedrooms of the home, the master bathroom, the garage, and the garden in backyard. Off limit areas are being made inaccessible by closed locked doors and baby gates. LPA observed the required postings and a working phone. 3B40BC fire extinguisher meets regulations. LPA observed smoke and carbon monoxide detectors, and verified they were both functional. LPA observed a restroom and verified that hazardous and toxic items were inaccessible to children in care.

Licensee stated there are no weapons in the home. There are no bodies of water on the premises. Outdoor play space is fenced. LPA observed living room area with age appropriate toys for children. LPA observed sleeping logs and individual sleeping plans for infants in care, per safe sleep regulations.

Children's files were reviewed. Emergency information and required immunization records were on file. LPA observed a current roster and documentation that a fire drill is conducted at least once every six months. Licensee's immunization records for measles (MMR), and pertussis (Tdap) were available in the facility file. Current in-person EMSA pediatric CPR and First Aid certification was verified and expires 05/2023 and Child Care Provider Mandated Reporter certification was verified and expires 06/2023.

Report continues on 809-C.
SUPERVISORS NAME: Sharon Ogbodo
LICENSING EVALUATOR NAME: Chayntel Hunter
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2021
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: ROGERS, LORI
FACILITY NUMBER: 574500012
VISIT DATE: 06/24/2021
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Prior to the inspection LPA reviewed new COVID19 self-assessment guide and conducted a technical assistance tour of the facility to incorporate Department of Public Health safety protocols for operating during the pandemic. LPA discussed posting requirements and facility operations including sanitation and pick up/drop off procedures.

LPA verified the annual fees are current.



This provider is not currently providing IMS services to children in care. 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.

This facility evaluation report was reviewed and discussed with Licensee. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for childcare updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. Licensee's signature on this form acknowledges receipt of this form. Appeal rights were printed and provided.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.
SUPERVISORS NAME: Sharon Ogbodo
LICENSING EVALUATOR NAME: Chayntel Hunter
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
LIC809 (FAS) - (06/04)
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