073409149-4-2-2021-02-CC-THAR-BZPPYP-20210402114415

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409149
Report Date: 04/02/2021
Date Signed: 04/02/2021 11:45:22 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:	PAYTON, MICHELLE		FACILITY NUMBER:	073409149
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	04/02/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	MICHELE PAYTON		TIME COMPLETED:	12:00 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	10:00AM: Licensing Program Analyst Alexander met today with Michelle Payton for an ANNOUNCED RE-LOCATION virtual tele inspection(zoom meeting call) due to COVID-19 pandemic. Applicant is the only one present for the inspection. The home is a one story house consisting of 4 bedrooms, 2.5 bathrooms, living room, dinning room, eat- in kitchen, laundry room and garage. The dinning room, 1st bedroom, hall half bathroom, kitchen and backyard will be used as the primary areas for day-care. The off limit areas will be the remaining 3 bedrooms which include the master bedroom and bath, full hall bathroom, laundry room and garage. These areas will be inaccessible to children in care by closed/and or locked doors and visual supervision. Applicant and her husband rent the home; proof was shown. There is a fully charged 2A10BC fire extinguisher, working smoke alarm and carbon monoxide detector; recommended periodic servicing. Per applicant, there are no firearms in the home. There are no pools, hot tubs or other bodies of water at the home. All sharp knives, cleaning solutions and medications are inaccessible to children. First aid kit is available and complete. The isolation area for sick children will be an area located in the 1st bedroom, which will be the infant room. Outdoor play will be in the backyard which is completely fenced. There are toys and play space available. Applicant was instructed to conduct and document periodic fire and disaster drills. Applicant was informed that baby walkers, exersaucers and baby bouncers are not allowed. Applicant has completed CPR and First aid training which expires 2/22/22 respectively. Applicant has completed her 16 hours of health and safety training which included the 1 hour of nutrition training and 1 hour of lead poisoning training. Mandated reporter and appeal rights were discussed. Licensing forms were reviewed and copies given to applicant. Applicant was instructed on the law establishing a $100 fine per day for adults who are living in the home or who are providing care who do not have fingerprint clearances. Applicant was also instructed on the law requiring notification to parents regarding exclusions. CONTINUED ON 809-C

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2021

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: PAYTON, MICHELLE	FACILITY NUMBER: 073409149
	VISIT DATE: 04/02/2021

NARRATIVE

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Individual 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

COVID-19 MATERIALS HAVE BEEN GIVEN AND DISCUSSED TODAY

THERE ARE NO DEFICIENCIES CITED TODAY. THIS HOME WILL BE LICENSED AS OF TODAY 4/22/2020

An exit interview was conducted This report must be available for public review for 3 years.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2021

LIC809 (FAS) - (06/04)

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