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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623049
Report Date: 09/09/2019
Date Signed: 09/09/2019 11:37:12 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:WEST, LAQUISHAFACILITY NUMBER:
343623049
ADMINISTRATOR:WEST, LAQUISHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 583-1665
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:14CENSUS: DATE:
09/09/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Laquisha West (Nacole)TIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Marea Behvand and Seychelle De Luca met with Laquisha West (Nacole) for the purpose of an announced pre-licensing change of location inspection (previous facility #343619345). Also present during the inspection today is applicant's minor daughter. All individuals have criminal record clearances.

A health and safety inspection was conducted inside and out. The one story home consists of two bedrooms, sitting room, two bathrooms, a family room, kitchen, converted garage, and fenced yard. The off-limits areas are master bedroom/bathroom, master bedroom patio, converted garage, and side yard. Applicant acknowledges she is required to notify licensing prior to making changes to the off-limit/on-limit areas, and off-limits areas will remain inaccessible to children by closed doors and/or supervision. There is a fireplace in the home that has been properly screened. Toxic and hazardous items are inaccessible to children. The applicant stated there are no poisons in the home. Functioning smoke and carbon monoxide detectors and a 3A40BC fire extinguisher were observed in the home. Current pediatric CPR and first aid training certificates were reviewed and expire 6/2020. Applicant stated there are no weapons in the home. There is a hot tub that is chained and locked with the use of a padlock on all four sides. Applicant was encouraged to maintain supervision at all times. Applicant understands that children must have 100% supervision in unfenced areas and during water activities. Immediate Civil Penalty regulation deficiencies were reviewed.

Continue on 809-C
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Marea BehvandTELEPHONE: (916) 216-7793
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: WEST, LAQUISHA
FACILITY NUMBER: 343623049
VISIT DATE: 09/09/2019
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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

Applicant is familiar with the required forms for children's record, employee records, and forms required to be kept on file at the facility. LPAs provided the Licensing Agency website(www.ccld.ca.gov), so the licensee may obtain updated licensing information, regulations, and forms.



During today's inspection, LPAs toured the entire home. LPAs did not observe daughter's bed. The applicant stated that she has not moved from her previous location yet because she is waiting to be licensed at this location. LPAs explained that she must be fully moved in and ready to provide care to children before a license will be issued.

The following must be submitted or completed prior to licensure:

-Applicant will send photos of the completed converted garage to LPA Behvand's cell phone.
-Applicant will send photos that she is fully moved in.
-LPM's final approval.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Marea BehvandTELEPHONE: (916) 216-7793
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2019
LIC809 (FAS) - (06/04)
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