293623985-6-28-2021-03-CC-BMOS-C4EPMS-20210628112649

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 293623985
Report Date: 06/28/2021
Date Signed: 06/28/2021 11:26:55 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	DYKES, SHARON		FACILITY NUMBER:	293623985
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	06/28/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Sharon Dykes - Licensee		TIME COMPLETED:	11:40 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 Monday, June 28th, 2021, at 9:56am, Licensing Program Analyst (LPA) Blake Morillas met with the Licensee, Sharon Dykes, for a Prelicensing - Change of Location inspection. This is a single story, 3 bedroom, 2 bathroom home. Licensee owns the home and provided the appropriate forms. The anticipated operating hours are 7:30am to 5:00pm, Monday through Friday, year around. At 10:03am, LPA initiated a health and safety inspection of all areas of the home as well as the outdoor area that will be used by the children in care. Off-limits areas will include the Master Bathroom and Garage. Licensee acknowledged that children may never enter these off-limit areas. There are stairs which are at the entrance to the home. The Licensee understands that before the front porch is to be used by the children in care, a barricade will be needed. The outdoor area used by children is a semi-fenced back yard with a deck, and an unfenced front yard. Licensee understands that 100% supervision is required when children are using any of the yards or deck. Age appropriate toys were observed. There are no bodies of water on the premises. Licensee stated there are no weapons in the home at this time but that may change. Licensee was informed to notify the LPA when weapons are in the home so a case management visit can take place. The Licensee was reminded of the Title 22 regulations when it comes to securing a firearm. Carbon monoxide and smoke detectors meet regulation. Hazardous cleaning compounds and medications are stored inaccessible and or out of children reach. There is no fireplace in the home. *Continued on LIC 809-C

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake Morillas	TELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: DYKES, SHARON	FACILITY NUMBER: 293623985
	VISIT DATE: 06/28/2021

NARRATIVE

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*Continuation of LIC 809

At this time, the Licensee does not carry liability insurance. LPA explained about obtaining a $300,000 annual aggregate/$100,000 per occurrence liability insurance policy. Licensee understands that until a policy is obtained, they must use the affidavit.

All adult residents received criminal record clearances. LPA reminded Licensee of the applicable Civil Penalty per person for those adults, including your own children, who have not received fingerprint clearances. LPA advised the Licensee of their responsibility to stay current with the requirements of the Department.

Licensee has certificates of completion for Preventative Health and Safety training including CPR/First Aid (expires: 6/2023) and Mandated Reporter Training. At 10:13am, LPA began to review Children’s files and other documentation that is required for operation of a day care. LPA reviewed the fire drill requirements.
LPA provided and discussed the Lead Testing brochure (AB 2370), Safe Sleep regulations, as well as current Covid-19 protocols and guidelines.

Licensee was encouraged to visit the Department website at http://ccld.ca.gov for child care updates, current forms, legislation and regulation information.

Incidental Medical Services (IMS) policy was discussed. 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

At 11:15am, LPA reviewed and discussed this facility evaluation report with the Licensee.

Effective today (6-28-2021) the facility is licensed to serve a MAX. CAP: 6 - NO MORE THAN 3 INFANTS OR 4 INFANTS ONLY. CAP 8 - NO MORE THAN 2 INFANTS, 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake Morillas	TELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021

LIC809 (FAS) - (06/04)

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