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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408970
Report Date: 08/24/2021
Date Signed: 08/24/2021 12:05:38 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:LEE, JASMINEFACILITY NUMBER:
073408970
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
08/24/2021
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:JASMINE LEETIME COMPLETED:
12:15 PM
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10:00AM, Licensing Program Analyst Tasha Alexander met with licensee Jasmine Lee for an announced ANNUAL/REQUIRED and INCREASE OF CAPACITY inspection. Present for the inspection were licensee and 2 preschool age children in care. LPA toured the facility and backyard for a health and safety inspection. The children's files were reviewed today and have immunization up to date immunization records. The home is equipped with a 2A10BC fire extinguisher that is fully charged, and working smoke detector/ carbon monoxide combo. There is a working telephone in the home. There is a fire arm located on the premises. The firearm is located in the off limits master bedroom closet and the ammunition is stored in a separate locked box . There is also a swimming pool located in the backyard with a 5ft self latching gate that meets the State Fire Marshall standards. The fountain located in the backyard has been filled in with dirt. All poisons, cleaning solutions and medications are inaccessible to children. Licensee has current CPR and 1st Aid training which includes nutrition and lead poisoning training, expires 6/2022 respectively. Today licensee requests to open up the off-limits backyard to children in care. An inspection has been conducted. Once the backyard is fully ready for children, licensee will contact LPA to officially take the backyard off limits. The off limits areas are all the entire upstairs, laundry room, garagare, and for the time being the backyard. Licensee was also informed of the licensing web address (www.ccld.ca.gov) for downloading child care forms and (www.myccl.com) to register to receive child care updates.
A review of staff records on 8/17/21 indicates that all facility staff or other individual who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

CONTINUED ON 809-C


SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: LEE, JASMINE
FACILITY NUMBER: 073408970
VISIT DATE: 08/24/2021
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Effective September 1, 2016, a person may not work or volunteer at a child care center or family child care home unless he or she has been vaccinated against pertussis, measles and influenza or has an exemption. Today licensee has immunization records in file and all are up to date.

The newly implemented mandatory mandated reporter training course was also discussed today. Licensee has a certificate of completion in file dated 8/2019. Licensee is reminded to update her training certificate before the end of this month.

As a result of this visit, there are no deficiencies cited today. This report must be available for public review for 3 years. An exit interview was conducted.



THIS HOME WILL BE LICENSED FOR A LARGE FAMILY CHILD CARE HOME EFFECTIVE TODAY 2/24/21.

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
LIC809 (FAS) - (06/04)
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