013423587-7-2-2020-02-CC-PDYR-BR5SMR-20200702140020

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423587
Report Date: 06/24/2020
Date Signed: 07/02/2020 02:00:32 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	ANDRADA, MIYANI		FACILITY NUMBER:	013423587
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	06/24/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Miyani Andrada		TIME COMPLETED:	11:00 AM

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) (Phyllis) Lisa Dyer conducted an announced Prelicensing Inspection. Due to the Covid-19 State of Emergency and the shelter-in-place mandate from the Governor’s office, the inspection was done via teleconference (FaceTime). Present were the applicant and her mother. The home was toured and consists of 2 bedrooms, 2 bathrooms, living room, dining room, and kitchen. Applicant will be utilizing the living room, dining room, kitchen and one bathroom for her day care area. Off limits areas are 1 bedroom and one bathroom. These areas will be inaccessible by closed and/or locked doors; gates and visual supervision. There are no toxins accessible today. There is a blocked wall heater. Licensee has no knives. There is a 2-A:10-B:C fully charged fire extinguisher, a working smoke detector (tested), carbon monoxide detector and multiple first aid kits. There are toys and play space available. Children will sleep on mats. Per applicant, there are no firearms or bodies of water on the premises. Fireplace is blocked by play equipment. Applicant has a cell phone. There is one fingerprint cleared adult that lives in the home. Applicant has completed CPR/FA and Preventative Health training. CPR/first aid expires 4/24/22. Documentation of Assembly Bill 1207/Mandated Child Abuse Reporting was discussed. Training can be accessed at: www.mandatedreporterca.com. (Child Care Provider Module). The applicant is renting the property. Backyard is securely fenced. There does not appear to be any dangerous hazards in the backyard such as poisons or toxins. There are no pets. Licensing forms were provided and reviewed to maintain facility and children's files; and to post in public area. Applicant was instructed to conduct and document periodic fire and disaster drills. Individual Medical Services and discipline methods were discussed. Applicant was instructed that spanking is not allowed. Proposed hours of operation: 7:00 am - 6:00 pm. The handout, "A Child Care Provider's Guide to Safe Sleep" was provided and discussed. Applicant was informed that baby bouncers, johnny jumpers, and saucer chairs were not allowed in the home; and that all persons 18 years of age or older who frequently visit, work or reside in the home shall be fingerprint cleared prior to being in the presence of day care children. Also discussed: children in parked vehicles; fingerprinting/association; advertisements; on-limit areas; (continued)

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2020

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ANDRADA, MIYANI	FACILITY NUMBER: 013423587
	VISIT DATE: 06/24/2020

NARRATIVE

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large family child care homes; and smoking.

Applicant was given Title 22 regulations, and reminded that licensing updates and forms can be located on our website: www.ccld.ca.gov.

For CCL Updates, go to www.ccld.ca.gov. Click the "Receive Important Updates" box. Enter your e-mail address.

It is recommended that a license be issued to this Family Day Care Home pending receipt of all final clearances and the completion of all requirements. A license will be processed as soon as administratively possible.

Exit interview conducted. Applicant was e-mailed appeal rights.

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2020

LIC809 (FAS) - (06/04)

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