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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 033622932
Report Date: 05/10/2021
Date Signed: 05/13/2021 08:52:33 AM

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:CABLE, CHONGFACILITY NUMBER:
033622932
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 7DATE:
05/10/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Chong CableTIME COMPLETED:
03:30 PM
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*NOTE: Due to Covid-19 State of Emergency and DPH guidelines on social distancing, a facetime meeting was conducted. In lieu of Licensee’s signature, the report is emailed with a read receipt request.*
On 10th May 2021 at 2:30pm, Licensing Program Analyst (LPA) Aruna Sridharan met with licensee, Chong Cable for the purpose of conducting case management visit for an increase of capacity. All adults residing in the home have a criminal record clearance. The hours of operation are Monday through Friday 6:00am to 5:30pm.
LPA Sridharan received the approved fire clearance for the increase of capacity on 01/21/2021. LPA toured the 3 bedrooms and 2 bath home and observed all areas of the home accessible to children. Childcare is conducted in the garage. Off-limit areas include master bedroom and bath. Licensee acknowledged that children may never enter these off-limit areas. Licensee stated there are no weapons in the home and LPA did not observe any bodies of water and fireplace is blocked by entertainment center. The front yard is unfenced and the backyard area is fenced.
The licensee understands that 100% supervision is needed when children are in an unfenced area. Licensee shall notify Licensing Agency per regulation 102416.3 prior to making altercations or additions to the home or grounds.
Carbon monoxide, smoke detector and fire extinguisher meet regulations. The fire extinguisher is wall mounted in garage and first aid kit is in garage closet. Hazardous cleaning compounds are stored in the pantry on the top shelf inaccessible to children. Knives are stored in the kitchen drawer with child safety latch inaccessible to children. The home contains appropriate toys for the children. LPA reviewed postings and records. LPA observed valid CPR/First Aid that expires 11/2022 and Mandated Reporter certifications that expires 11/2022, proof of immunizations for licensee and resident assistant.
Licensee is following COVID guidelines and precautions to provide care for children at this time. LPA advised the licensee of their responsibility to stay current in the requirements of the Department.
A large license is issued on today's date May 10, 2021, for a capacity of 14 with the following capacity; 14 children, two (2) of which must be at least 6 years of age and no more than three (3) may be infants; or 12 children, four (4) of which may be infants. Infants are children under the age of 2. Licensee understands when not using an assistant the capacity reverts back to the small family day care home license capacity.
No Title 22 deficiencies cited during today's visit. Notice of Site Visit Posted.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021
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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