214005378-6-12-2020-05-CC-FBTQ-BQHU5Z-20200612151731

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005378
Report Date: 06/12/2020
Date Signed: 06/12/2020 03:17:41 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	JONES, ANDREIA		FACILITY NUMBER:	214005378
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	06/12/2020
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Andreia Jones		TIME COMPLETED:	11:45 AM

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Licensing Program Analyst (LPA), Farhan Bashir-Tariq conducted a scheduled case management inspection for capacity increase on 6/12/20 with Licensee, Andreia Jones. This inspection was conducted via face time due to COVID-19. Purpose of the inspection was explained. There were five children present today with Licensee and a helper, Esmeralda Lopez. Licensee rents the home and lives with mother and daughter. All adults living or working in the home have fingerprints clearance on file. Hours of operation are: M-F, 8:00 AM – 5:30 PM. Licensee provides breakfast, lunch and two snacks.

LPA and Licensee inspected the entire day care area for Health and Safety hazards. LPA observed that off limit areas were properly barricaded and made inaccessible to the children in care. There were multiple carbon monoxide detectors and smoke detectors available in the home. Licensee performed the tests to check the functionality of the detectors. A Fire Extinguisher of size 2A10BC or bigger and a working telephone was also available in the home. First Aid kit is fully stocked and accessible. Per Licensee, there are no firearms or weapons in the home. Licensee states, there are no bodies of water in the home. Licensee has a small cat in the home. Children play in the back yard and LPA observed back yard is fully fenced all around. There were plenty of toys, books and other learning materials available. Stairs leading to upper level were properly barricaded by installing baby gates on both ends. Electric outlets in day care areas were secured with child safety covers. All posting requirements are met.

Both Licensee and Helper have current and valid CPR and First Aid cards expiring in September 2021 and December 2021, respectively. LPA reviewed facility's fire drill log and Per Log, last drill was conducted on May 4, 2021. Licensee is aware of the requirement of conducting and logging fire drills once every six months. Department has already received fire clearance for a large family childcare home from San Rafael Fire Department. LPA informed Licensee that all children and adults file shall be kept updated at all times. Children files shall contain all relevant documents, emergency contact information and immunization records.

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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2020

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: JONES, ANDREIA	FACILITY NUMBER: 214005378
	VISIT DATE: 06/12/2020

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LPA reminded Licensee that As of January 1, 2018, all staff is required to complete Mandated Child Abuse Reporter Training (AB1207) every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed training completion certificates for both License and helper. LPA encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Facility can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

Large Family Child Care Home License is approved and will be effective as of today, 06/12/20.

This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Licensee was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800. For Rules and Regulations, visit the Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2020

LIC809 (FAS) - (06/04)

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