173009886-1-27-2020-01-CC-NCUM-BKWRXV-20200117122520

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 173009886
Report Date: 01/17/2020
Date Signed: 01/27/2020 10:37:42 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME:	JOYCE, JACQUELYN FCCH		FACILITY NUMBER:	173009886
ADMINISTRATOR:	JOYCE, JACQUELYN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(702) 286-3356
CITY:	LAKEPORT	STATE: CA	ZIP CODE:	95453
CAPACITY:	14	CENSUS: 0	DATE:	01/17/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Jacquelyn Joyce, Applicant		TIME COMPLETED:	12:45 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	A pre-licensing inspection was conducted today by Licensing Program Analyst (LPA) N. Cunningham. The applicant has submitted a change of location application and a requested to increase capacity. The applicant was previously licensed as a small FCCH at 360 Konocti Ave., Lakeport (facility #173009493). The applicant is requesting a license for a capacity of 14 children. The Lakeport Fire Department conducted a Fire Safety Inspection on 01/13/20 and the facility was granted a fire clearance to operate at a capacity of 14. Facility hours will be 7:30 a.m. - 5:30 p.m., Monday – Friday, January - December. The applicants understand that 24-hour consecutive care is prohibited. There is one adult living in the home. Applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance. Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. The applicant stated she currently has liability insurance and plans to transfer her policy. The floor plans are verified. The children will have access to the living room, kitchen, dining room, bathroom, front yard and back yard. The entire upstairs of the home and the garage are "off limits" to the day care children. These areas have been made inaccessible by a child gate and door locks. The home appears to be clean and orderly at this time and will remain so during child care hours. There is a working telephone. Items which could pose a danger to children such as sharp knives, cleaning supplies, and medicines, are stored out of the reach of children in a high cupboard in the inaccessible kitchen. The applicant states there are no firearms or weapons and none were observed during this inspection. Applicant states no poisons will be stored on the property. First Aid supplies are kept in the kitchen cabinet. The children in care will have access to age appropriate toys and equipment. The home is equipped with a working smoke detector, carbon monoxide detector and fire extinguisher rated at least 2-A 10:BC. Continued on LIC 809-C.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Nicolette Cunningham	TELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020

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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: JOYCE, JACQUELYN FCCH	FACILITY NUMBER: 173009886
	VISIT DATE: 01/17/2020

NARRATIVE

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The home is heated by a kerosene unit. The children will use the front yard and backyard as the outdoor play area; both areas are completely fenced. There is no trampoline, pool, pond, or fountain on the property.

Incidental Medical Services regulations were reviewed with the applicant. The applicant understands that if Incidental Medical Services are provided, an updated Plan of Operation shall be submitted and on file with the Department. Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. Proof of control of property or landlord notification/consent is on file. Parent's rights are posted. Emergency drills must be conducted at least once every six months and the date documented. Children's records to be maintained were reviewed. The roster is to remain current at all times. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days. The applicant will maintain current on Pediatric CPR and First Aid. CPR and First Aid cards expire in 2/2021. The applicant shall be present in the home and shall ensure that children in care are supervised by a fingerprinted adult with current Pediatric CPR and First Aid certification. The applicant understands that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. Infants or children shall not be allowed to sleep in car carriers in the home. The applicant clearly understands the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school aged. Smoking is prohibited at all times in any area where child care is provided. The applicant understands the responsibility to read and have knowledge of the laws and regulations for operation of a family child care home. Forms and regulations may be obtained from the website http://ccld.ca.gov. Megan's Law web site was provided (http://www.meganslaw.ca.gov).

The applicant understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice. Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

The following needs to be completed prior to the license becoming active.
secure all bookcases and cubby furniture
place a barrier around the kerosene heater
clean bathroom floor

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Nicolette Cunningham	TELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020

LIC809 (FAS) - (06/04)

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