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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409269
Report Date: 06/01/2022
Date Signed: 06/01/2022 08:45:36 PM


Document Has Been Signed on 06/01/2022 08:45 PM - It Cannot Be Edited

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:BELLOT, JANEENAFACILITY NUMBER:
073409269
ADMINISTRATOR:BELLOT, JANEENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 726-6853
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:14CENSUS: 12DATE:
06/01/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:JANEENE BELLOTTIME COMPLETED:
12:15 PM
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9:00am- Licensing Program Analyst Alexander met today with Janeene Bellot for an ANNOUNCED RE-LOCATION INSPECTION. Applicant, her finger print cleared assistant and 12 children consisting of 3 infants, 8 preschoolers and 1 school age are present the inspection. The home is a two story house consisting of 5 bedrooms,3 bathrooms, living /dinning room, kitchen, family room, laundry room and garage. The family room, downstairs bedroom, downstairs hall bathroom and right side of the backyard which is fully fenced will be used as the primary areas for day-care. The off limit areas will be the entire upstairs which includes the remaining 4 bedrooms and 2 bathrooms, the downstairs laundry room, the garage and the larger area of the backyard. These areas will be inaccessible to children in care by closed/and or locked doors, visual supervision and a safety gate at the bottom of the stairs. Applicant owns the home; proof was shown. There is a fully charged 2A10BC fire extinguisher and working smoke detector/carbon monoxide combo; 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 living room. Outdoor play will be in the smaller section of the backyard located near the garage which is fenced off from the larger part of the backyard. 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's CPR and First aid training cards are up to date. Applicant has completed her 16 hours of health and safety 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 DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2022
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: BELLOT, JANEENA
FACILITY NUMBER: 073409269
VISIT DATE: 06/01/2022
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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. Licensee's vaccinations are in file. Licensee declines the flu vaccine

Liceinsee's mandated reporter training course certificates are up to date and expires in 2024.

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
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022
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: BELLOT, JANEENA
FACILITY NUMBER: 073409269
VISIT DATE: 06/01/2022
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inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

There are no deficiencies cited today. This home will be licensed for a large fcch as of today 6/1/22.

An exit interview was conducted. A notice of site visit was posted

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

DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022
LIC809 (FAS) - (06/04)
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