343623021-6-7-2019-03-CC-JKEY-BCWPDX-20190607111415

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623021
Report Date: 06/07/2019
Date Signed: 06/07/2019 11:16:01 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	BASS, AMANI		FACILITY NUMBER:	343623021
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	06/07/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Amani Bass, Applicant		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	Licensing Program Analyst (LPA) Joleen Kenney met with applicant Amani Bass for the purpose of a pre-licensing inspection. During today's inspection the Applicant and Applicant's minor children were present in the home. LPA and Applicant toured the entire 1 story home both inside and out. The facility consists of 4 bedrooms, 2 bathrooms, living room, dining room, garage and back yard. Off limit areas will consist of bedroom #1, #2, #3, garage and shed. LPA obtained a copy of the mortgage statement from the homeowner to show control of property. Applicant has completed the required Preventative Health and Safety course which includes 1 hour of nutrition. Applicant's CPR and First aid certification was verified. LPA provided blank forms required for children's records including immunization card and proposed Safe Sleep Regulation Concepts. LPA also provided the Parent's Rights form/poster, new regulations were reviewed which include seat belt/booster seat laws, vaccination requirements for staff and children, and smoking prohibition. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 There were no bodies of water at the home. Applicant stated that there are no weapons in the home. Cleaning compounds, knives and medications are inaccessible to children. (report continued on next page, LIC809C)

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen Kenney	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019

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: BASS, AMANI	FACILITY NUMBER: 343623021
	VISIT DATE: 06/07/2019

NARRATIVE

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LPA observed a 2A10BC fire extinguisher, an operational smoke and carbon monoxide detector in the home that meet regulatory standards. There is no fireplace in the home. LPA advised the applicant that if there are any poisons at the home, all poisons must be locked with a key lock or combination lock.

Applicant has completed the required AB1207 Mandated Reporter training. Applicant understand that the training must be completed once every two years, training is accessible at www.mandatedreporterca.com.

Applicant understands that a current roster must be maintained and that a fire drill must be conducted and documented once every six months.

Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. LPA explained to applicant that if she relocates and wants to continue to provide care, she must submit a change of location application and have the new home inspected.

Applicant understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within seven days to remain in compliance.

Applicant understands that if any structural changes are made to the home; licensing must be notified prior to construction.

This facility evaluation report was reviewed and discussed with the applicant. Records, postings and reporting requirements were discussed. LIC311D was provided and discussed. Applicant was encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

As of today 6/7/2019 facility is approved for a Small Family Child Care Home license for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen Kenney	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019

LIC809 (FAS) - (06/04)

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