343622322-4-16-2020-03-CC-JKEY-BNQQEN-20200416120637

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343622322
Report Date: 04/16/2020
Date Signed: 04/16/2020 12:06:53 PM

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:	KHANI, ANGELA		FACILITY NUMBER:	343622322
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	04/16/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Angela Khani, Licensee		TIME COMPLETED:	11:05 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	Licensing Program Analyst Joleen Kenney contacted Licensee Angela Khani regarding her request for a capacity increase. The Licensee requested to increase the capacity from 8 to 14 children. The facility was granted a fire clearance by the Sacramento Fire Department on 3/24/2020. Due to COVID-19 pandemic, LPA is conducting the meeting via FaceTime with the Licensee. During the FaceTime visit, LPA Kenney requested to tour the facility. LPA observed four children being supervised by the Licensee and one Assistant. The facilities hours of operation is from 6:00 AM to 6:00 PM Monday – Friday. The facilities annual fees are current. All individuals subject to criminal background review have obtained a criminal record clearance. A health and safety evaluation was conducted in all areas accessible to children. Off-limits areas consist of the entire upstairs, laundry room and garage. LPA observed a working phone, 2A10BC fire extinguisher, first aid kit and functioning smoke and carbon monoxide detectors. Per Licensee, there are no weapons in the home. There are no accessible bodies of water on the premises. Toxic and hazardous items are inaccessible to children. Safe toys and comfortable accommodations were observed. The fireplace is appropriately barricaded to prevent access by children. The fenced backyard is accessible for children to play. Licensee understands that 100% supervision is required in unfenced areas. Licensee does not provide Incidental Medical Services (IMS) at this time. For IMS information, licensee was advised to see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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. Report continued on LIC809-C

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen Kenney	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2020

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

FACILITY NAME: KHANI, ANGELA	FACILITY NUMBER: 343622322
	VISIT DATE: 04/16/2020

NARRATIVE

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Required postings were observed. Current EMSA Certified pediatric CPR and first aid certification was verified and expires: 08/12/2020.

LPA observed a completed Mandated Reporter Training certificate for the Licensee which was taken on 7/24/2018. Licensee is aware that the training has to be renewed every two years and is available through www.mandatedreporterca.com.

LPA discussed proposed safe sleep regulations and lead exposure regulations.

Effective today's date 4/16/2020, LPA will approve the capacity increase to serve up to either 14 children, two (2) of which must be at least 6 years of age and no more than three (3) may be infants; or 12 children, four (4) of which may be infants. Infants are children under the age of 2. Licensee is aware that if an assistant is not present the requirements convert to small license regulations.

In lieu of Licensee's signature, LPA Kenney is e-mailing the report with a read receipt request. A notice of site visit will also be emailed and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen Kenney	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2020

LIC809 (FAS) - (06/04)

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