343622955-7-20-2020-53-CC-JHOA-BRPSAW-20200720134302

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343622955
Report Date: 07/20/2020
Date Signed: 07/20/2020 01:43:12 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:	JONES, ANTONIO		FACILITY NUMBER:	343622955
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	07/20/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Antonio Jones		TIME COMPLETED:	10:00 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, 7/20/20 at 8:30am, Licensing Program Analyst (LPA), Jan Hoshida, met with Licensee, Antonio Jones, via Zoom due to COVID-19 pandemic, for the purpose of an increase of capacity inspection. Licensee applied to change from a Small Family Child Care Home to a Large Family Child Care Home. LPA observed that there were two day care children and his assistant in the home. The two-story home has an open front yard, four bedrooms, three bathrooms, a living room, dining room, kitchen, garage, and fenced backyard. Licensee stated that the children use the garage area for about 10% of the day and never sleep in the garage. The off-limits areas in the home are the entire upstairs, laundry room, front room, dining room and downstairs bedroom. During the inspection, Licensee requested to put the downstairs bedroom on-limits. LPA inspected the downstairs bedroom and observed that it was in compliance with Title 22 regulations and the Health and Safety Code. LPA approved the downstairs bedroom for use starting 7/20/20. Licensee acknowledged that children may never enter the off-limit areas. Licensee acknowledged that if he would like to change an off-limits area to on-limits, he will inform LPA prior to using the space for inspection and approval. Licensee stated there are no new residents in the home since licensure. All adult residents have criminal record clearances. Hours of operation are Saturday through Sunday from 8:00am to midnight. During the Zoom inspection, LPA Hoshida requested a tour of the facility. LPA and Licensee conducted a health and safety inside and out the home. A fire pull, functioning smoke and carbon monoxide detectors and fire extinguisher were observed in the home. The Fire Safety Inspection Clearance has been received from the Cosumnes Community Services District Fire Department and the home has been cleared as of 7/13/20. *REPORT CONTINUED ON NEXT PAGE*

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2020

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: JONES, ANTONIO	FACILITY NUMBER: 343622955
	VISIT DATE: 07/20/2020

NARRATIVE

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LPA observed that there were no hazardous items accessible to children. Licensee stated that he understands that any poisons must be kept under lock and key. LPA observed that cleaning materials were inaccessible. Licensee stated there are no weapons in the home. Toys appear to be safe. The backyard is fenced and gated. LPA observed an empty and non-operating water fountain feature in the backyard. Licensee stated the fountain is never used and understands that there can be no standing water. Current pediatric CPR and first aid training was verified and expires on 9/24/2020. The electric fireplace was properly screened, and Licensee stated that is never used. LPA discussed recent changes in licensing requirements, including the posting of licensing inspection notices and reports and Parent Notification Requirements. LPA reviewed some files.

This facility evaluation report was reviewed and discussed with the Licensee. Records, postings and reporting requirements were discussed. Licensee was encouraged to visit the department website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, self-assessment guides, regulations and legislation pertaining to family child care homes. LPA also included the email address for the children's advocacy program to stay current on new laws CHILDCAREADVOCATESPROGRAM@DSS.CA.GOV.

Effective today 7/20/20, facility is approved for a Large Family Child Care License to serve 12 children (when there is an assistant present) with no more than 4 infants, or capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or above and 1 child at least age 6 with a maximum of 3 infants. Without assistant, the ratios revert to those for small family child care home. An exit interview was conducted and Notice of Site Visit was provided.

Facility evaluation report was emailed to Licensee and an email verification of receipt of report will be used in lieu of a signature on this report.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2020

LIC809 (FAS) - (06/04)

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