073408994-12-4-2019-02-CC-SNEN-BJJMYX-20191204090217

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408994
Report Date: 11/26/2019
Date Signed: 12/04/2019 09:02:27 AM

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:	FORD, TAMIKA		FACILITY NUMBER:	073408994
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	11/26/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Tamika Ford		TIME COMPLETED:	05:00 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	An announced prelicensing site inspection visit was conducted by LPA Susan Neeson . Met with Tamika Ford. Visit began at 2:45 PM. Tamika Ford stated that she resides here with her two school age children. Her fingerprints are clear. There are no day care children present. The home is a single family home. It consists of 3 bedrooms, kitchen, living dining area and a small sun room. All bedrooms are off-limits. The large yard will be off-limits until it has some work done on it. The front yard will be used. Additionally children will be taken to a nearby park for additional outside play. The home has one bathroom which will be used for the children in care. The fireplace is barricaded and will not be used. There is a fire extinguisher, smoke alarm and carbon monoxide detector. There are ample toys and equipment for children. Electrical outlets are covered, cleaning products are stored in a locked cabinet. Medicines and cosmetics are stored on a high shelf in a locked closet. The 16-hour health and safety class has been completed by Tamika Ford. The family has no pets. There are no bodies of water. Tamika ford states that there are no guns or firearms on the premises or in any storage areas. All forms necessary for doing Family Day Care were issued and discussed. Safe Sleep for infants was discussed. Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov and for day care updates visit www.myccl.gov

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan Neeson	TELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

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: FORD, TAMIKA	FACILITY NUMBER: 073408994
	VISIT DATE: 11/26/2019

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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

Before a license can be recommended, there are several items in the home that need to be fixed. The wall heater needs a secure barricade. Also, a larger capacity application will be submitted. This will require a fire clearance.

An exit interview was given. Appeal rights were discussed.

THE REPORT WAS NOT ISSUED DURING THE VISIT DUE TO MECHANICAL MALFUNCTION.

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan Neeson	TELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

LIC809 (FAS) - (06/04)

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