214005478-8-11-2020-05-CC-KMEO-BSDPA9-20200811110821

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005478
Report Date: 08/11/2020
Date Signed: 08/11/2020 11:10:01 AM

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:	FREEMAN-NOYOLA, JENNIFER SCOTT		FACILITY NUMBER:	214005478
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	08/11/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	10:26 AM
MET WITH:	Licensee, Jennifer Freeman-Noyola		TIME COMPLETED:	11:15 AM

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	On August 11th, 2020 at 10:30 am, Licensing Program Analyst (LPA), Kassandra Medrano, met with Licensee, Jennifer Freeman-Noyola. The purpose of the inspection was explained and was for a Case Management inspection for an increase of capacity. LPA and Licensee inspected entire home and yard via tele-video for Health and Safety Hazards. Present in the home is Licensee and 6 children with one helper. Day Care Areas: entire bottom floor, off limit area is the entire second floor. The child care operates 7am-5:30pm, Monday through Friday. LPA observed the following: Stairs in the home are properly barricaded if caring for children under five years old. Day-care area is clean, orderly, and equipped with age appropriate toys and equipment for the children. No baby walkers, bouncers, exercausers, etc. allowed to be used during child-care hours. Home has proper lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher. Licensee states there are no bodies of water on the property.There is not a fireplace in the day-care area. There are no detergents, or cleaning products accessible to day-care children. Poisons are locked. Licensee states there are no guns or weapons of any kind in the home. The yard is fenced. Licensee states there are not pets in the home. Licensee’s CPR and First Aid has expired, but due to covid she has not been able to reschedule until now. She now has it scheduled for November 7th,2020. Emergency drills are conducted at least once every six months and properly logged. Licensee provides daily snacks and meals. Isolation of sick children reviewed/discussed, during todays visit a televisit for COVID-19 was also completed.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2020

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: FREEMAN-NOYOLA, JENNIFER SCOTT	FACILITY NUMBER: 214005478
	VISIT DATE: 08/11/2020

NARRATIVE

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Capacity options were reviewed. Licensee understands that care cannot be provided for more than the capacity as stated on the license. Requirements for reporting suspected child abuse was discussed, as well as reporting requirements for unusual incidences. All required postings are properly posted (License/Parent’s Rights poster/Emergency Disaster Plan and Earthquake Preparedness Checklist)

Capacity limits of a Small and Large License have been reviewed with Licensee. Licensee is reminded that when operating at a Large capacity, there must be a Helper present.

License will be recommended for approval when the following is updated and proof is received in office: Fire Clearance.

No deficiencies were issued today under Title 22 Division 12 of the Ca. Code of Regulations.

This report and Notice of Site Visit will be emailed to Licensee. Rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Additional questions, call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2020

LIC809 (FAS) - (06/04)

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