034500273-9-15-2020-53-CC-ASRN-BTGUYD-20200915155947

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 034500273
Report Date: 08/24/2020
Date Signed: 09/15/2020 03:59:59 PM

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:	CLARK, JENNA		FACILITY NUMBER:	034500273
ADMINISTRATOR:	CLARK, JENNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 256-9900
CITY:	PIONEER	STATE: CA	ZIP CODE:	95666
CAPACITY:	14	CENSUS: 1	DATE:	08/24/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Jenna Clark		TIME COMPLETED:	01:00 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) Aruna Sridharan conducted televisit due to COVID-19 State of Emergency for the purpose of change of location. The televisit was conducted on Facetime. Licensee Jenna Clark applied for a change of location for a large family child care home. Previously, licensee was licensed at different location with license number 33621943 at 224 Westview Dr., Jackson CA 95642. The family child care home facility is two story single family home with three bedrooms and two bathrooms. Licensee lives with three minor children. Licensee and staff have criminal background clearances. The daycare will be conducted in the garage area converted and the hours of operation are Monday through Friday from 6:00am to 6:00pm.. Off limit areas: Entire upstairs on second floor and two bedrooms on ground floor. All off limits areas must be made inaccessible to children. Isolation of an ill child will be in Living room. Licensee was notified that prior to use of any off limits area, the department must be notified. LPA Sridharan tele-inspected the home with the applicant for health and safety hazards. The house has proper temperature and ventilation. All the toxic or dangerous materials are stored in coat closet. The fireplace in family room and the stairs are barricaded. The house has a working telephone, fully charged fire extinguisher, smoke detector and carbon monoxide detector that meet regulations. There is first aid kit available. There is a variety of age appropriate toys available. As per the licensee, there are no firearms or weapons in the home. Per licensee, she has one dog in the house and has record of immunization of the dog. Report continues on next page 809C ...........

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2020

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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: CLARK, JENNA	FACILITY NUMBER: 034500273
	VISIT DATE: 08/24/2020

NARRATIVE

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LPA discussed licensing regulations and capacity requirements. Licensing forms and posting requirements were reviewed with the licensee. During the inspection, LPA received copies of Deed, Lead Poisoning Prevention Completion certificate, CPR/First Aid Card that expires 06/21 and Mandated Reporter Certification expires 09/22. LPA observed the record of licensee’s immunization on file. During the inspection, LPA received updated Application and Current Children in home form from applicant. LPA requested children's roster from the licensee. LPA informed applicant that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

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

LPA discussed the inspection authority of the Department by authorized agent to enter and inspect the family child care home providing care, supervision and services at any time, with or without advance notice to secure compliance with the regulations in accordance with Section 102396.
LPA discussed that prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changes.
The applicant is encouraged to frequently visit website at http://www.ccld.ca.gov for licensing regulations and new updates. Applicant can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

LPA did not observe any violation of regulations. As of 08/24/2020, the license is granted for Large Family Child Care Home for this location. Copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2020

LIC809 (FAS) - (06/04)

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