073404606-9-13-2019-02-CC-GRED-BFYPT2-20190913113512

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073404606
Report Date: 09/13/2019
Date Signed: 09/13/2019 11:35:34 AM

COMPREHENSIVE INSPECTION

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:	MAC, JASMINE		FACILITY NUMBER:	073404606
ADMINISTRATOR:	MAC, JASMINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 689-3766
CITY:	CONCORD	STATE: CA	ZIP CODE:	94521
CAPACITY:	14	CENSUS: 8	DATE:	09/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	MAC, JASMINE, LICENSEE		TIME COMPLETED:	11:35 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) Redmond, arrived at the facility to conduct a health and safety inspection to ensure Licensee’s compliance with Title 22, CCR and Health and Safety Code Statutes. During the inspection, LPA met with Jasmine Mac, Licensee. Licensee accompanied LPA during the inspection. LPA inspected all areas of the facility which are accessible to children. Additionally, LPA reviewed records. LPA made observations during the inspection which are noted below: Capacity/Staffing: The facility operates as a Family Day Care (large), with a capacity of fourteen (14) children. On this date, there are eight (8) children including two (2) infants in care. There are two (2) staff persons including the Licensee present. The facility is an in compliance with capacity limitations, child ratios and staffing levels. "On Limit" Areas (accessible to children in care): · Living room · Family room · Hall · Restroom · Kitchen · Bedroom (mainly used for sleep) · Back yard "Off Limit" Areas (not accessible to children in care): · Upstairs · Private bedroom

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019

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: MAC, JASMINE	FACILITY NUMBER: 073404606
	VISIT DATE: 09/13/2019

NARRATIVE

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Emergency Preparedness/Safety: There is are smoke and carbon monoxide detectors. Both were tested during the visit and found to be operable. There is a fully charged fire extinguisher, with an appropriate classification of (2-A:10-B:C). First aid supplies available. Emergency Disaster Plan is dated, 10/18/04 and is current, per Licensee. Fire and earthquake drills were last conducted on 04/08/19 and meet six (6) month requirement. There is a land-line used for telephone service. Per the Licensee, there are no firearms present. The Licensee is not currently providing *Incidental Medical Services (IMS) for children in care. Licensee provides care and supervision to infants, LPA discussed Safe Sleep Requirements with Licensee the following link is provided: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep

Training/Record Review:
Licensee and adults residing in the home have criminal background clearances and are associated to the facility. Licensee has current CPR/First Aid training, which, expires on 03/10/20. Licensee and assistant have current, Mandated Reporter training, dated, 05/11/19.

Posted as required: Facility License, Emergency Disaster Plan, Notification of Parent's Rights, Earthquake Preparedness Checklist, If You See Something, Say Something.

Staff Immunization: Licensee has immunization records on file for self and assistant, including tuberculosis and influenza.

Overall, the facility is clean and orderly and in good repair. There is heating and ventilation. There are safe, healthful and comfortable accommodations, furnishings and equipment. There are age appropriate toys and materials for children.

FACILITY IN SUBSTANTIAL COMPLIANCE. NO DEFICIENCIES CITED ON THIS DATE.

Exit interview conducted. This Facility Evaluation Report discussed with the Licensee and signature obtained below. Notice of Site Visit was issued and shall be posted remain posted for 30 days. Failure to keep this notice posted for the 30 consecutive days will result in an immediate $100 civil penalty. A copy of this report shall be maintained for 3 years and available for public review upon request.

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019

LIC809 (FAS) - (06/04)

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