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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623429
Report Date: 12/31/2019
Date Signed: 12/31/2019 10:18:12 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:MALONE, TIANDRAFACILITY NUMBER:
343623429
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
12/31/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Tiandra MaloneTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Kelly met with the applicant at the home for the purpose of a Change of location/Pre-licensing inspection. LPA Kelly toured the home inside and backyard.
The home is a 2 story, 4 bedrooms, 2.5 bath house. Off limit areas include: Entire second floor and garage. The applicant provided proof of ownership. LPA explained about obtaining $300,000 liability insurance. She understands that until a policy is obtained, she must use the affidavit. LPA provided a copy of affidavit to the applicant.
Applicant has CPR/First Aid Cards. All adults in the home are fingerprint and child abuse cleared. Applicant stated that there are no firearms in the home. Smoke and Carbon monoxide detectors and Fire extinguisher meet Title 22 Regulation. Cleaning compounds were out of reach of children. Medications are stored out of reach of children. There were no accessible hazardous materials or chemicals observed. There were no hazardous materials in the bathroom. The backyard is fenced, and there were no bodies of water on the property.

LPA reviewed forms for children's records and provided copies of the forms. LPA discussed and reviewed Health & Safety code: 1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions. 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
LPA also discussed safe sleeping practices and provided a copy of the Fact Sheet-AB 633 Child Parent Notification. LPA discussed the unusual incident reporting, fingerprinting policy and TB testing requirements for adults. LPA discussed fire drills with the applicant, as well as Zero Tolerance Type A deficiencies and the immediate civil penalty imposed if cited with a Zero Tolerance Type A deficiency.
LPA provided applicant with the Division website:(www.ccld.ca.gov) so that applicant can obtain forms and review regulations.
As of today's date 12/31/19, LPA will grant a license to serve up to either 8 children, two (2) of which must be at least 6 years of age and no more that two (2) may be infants; or 6 children, three (3) of which may be infants; or 4 infants only. Infants are children under the age of 2 years.

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Socorro KellyTELEPHONE: (916)216-7792
LICENSING EVALUATOR SIGNATURE:

DATE: 12/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2019
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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