198400154-5-27-2020-54-CC-RJOS-BPZQWU-20200527123232

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400154
Report Date: 05/27/2020
Date Signed: 05/27/2020 12:33:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	KEITH & HOLLINS FAMILY CHILD CARE		FACILITY NUMBER:	198400154
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	05/27/2020
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	10:59 AM
MET WITH:	Bionka Keith; Licensee		TIME COMPLETED:	12:31 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

Licensing Program Analyst (LPA) Reiko Jones-Modeste conducted a pre-licensing inspection to increase capacity at the facility listed above. Due to COVID-19 and precautionary measures the inspection was conducted with the Licensee via a tele-inspection using FACETIME.

During this tele-inspection the Licensee guided the LPA on a tour of the facility.

LPA observed the licensees Bionka Keith and Brandon Hollins alone at the facility. Per the Licensee two adults and five children currently reside in the home. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed family child care home. The Fire Department has granted clearance for a maximum capacity of 14 children, fire clearance received on May 19, 2020. LPA observed a fire alarm installed on the living room wall per the Fire Marshall's request.

All areas identified on the facility sketch were inspected. This is a one-story home that includes two bedrooms, one full restroom, kitchen, dining room and living room. Licensee observed the living room/children’s area with various children’s toys and equipment. Licensee also observed the front bedroom also a children’s area with various children’s games and equipment including a small cubby and Pack-n-Play by Cosco. Licensee observed wall heater barricaded.
2^nd bedroom is an off-limits area to children in care. LPA observed the door closed with a lock and key. LPA observed kitchen area barricaded to children in care.

Accessible to daycare children: one bedroom, restroom and living room

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko Jones	TELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KEITH & HOLLINS FAMILY CHILD CARE	FACILITY NUMBER: 198400154
	VISIT DATE: 05/27/2020

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
26
27
28
29
30
31
32

LPA also observed First Aid CPR certification for the following adults:

Bionka Keith_expires July 2020
Brandon Hollins_expires July 2020

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today. LPA will recommend the increase in capacity as the licensee meets requirements for an increase and the fire clearance was received and granted for 14 children.

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov

Per applicant, there are no other licenses held at this location.

Once licensed, the applicant is required to adhere to the terms and limitations as stated on the license.

Upon receipt the Licensee shall post the Notice of Site Visit. This report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview was conducted with the Licensees Brandon Hollins and Bionka Keith via tele-inspection, during which appeal rights were explained. This report along with a copy of the appeal rights will be sent to the Applicant via email with a read receipt or confirmation of receipt of email, which will act as the Applicants signature. A copy of this report and all other licensing reports must be made available to the public for 3 years.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko Jones	TELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2