343623429-6-12-2020-03-CC-ESIA-BQHV3G-20200612160442

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623429
Report Date: 06/12/2020
Date Signed: 06/12/2020 04:05:03 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:	MALONE, TIANDRA		FACILITY NUMBER:	343623429
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	06/12/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Tiandra Malone		TIME COMPLETED:	02:30 PM

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 Friday June 12, 2020 at approximately 01:00 PM Licensing Program Analyst (LPA) Elvira Sierra contacted Licensee Tiandra Malone for the purpose of an announced pre-licensing/increase of capacity tele-inspection. Licensee had recently submitted an application for an increase in capacity from 8 to 14 children. Due to COVID-19 pandemic LPA is conducting the meeting via FaceTime. Licensee operate M-F from 06:00 AM to 05:30 PM. Present during the tele-inspection was Licensee caring for 3 children (2 infants, 1 preschool). Once infant is licensee's own child.

A health and safety inspection was conducted inside and out. This facility is a two story home which consists of 4 bedrooms (located upstairs), 3 bathrooms, living room #2, play room (Living Room # 1), kitchen, backyard, front yard and garage. The off-limit areas in the home will consist of; Entire second floor, garage, front yard and driveway. Stairs leading to the second floor are properly barricaded. Fire extinguisher, smoke and carbon monoxide detectors meet regulation. Sharp knives are stored in a kitchen cabinet above the counter. Toxins and cleaning supplies are inaccessible to the children. Toys appear to be safe and appropriate for children in care. Licensee stated that there are no weapons in the home and no bodies of water. The facility currently does not provide Incidental Medical Services – IMS. LPA discussed IMS services and the requirement to create a plan of operation. Specifics on the plan can be found in the family childcare home evaluator manual (FCCH EM) Policy 102417.

Adult residents and assistants have criminal record clearance. No additional adults have moved into the home since licensure. A current CPR/First Aid was verified and expired on 06/20. Licensee stated that she has an appointment on 06/13/20 to renew CPR. Licensee was advised to mail proof of renewal of CPR to Licensing office. Licensee’s Mandated Reporter Training Certificate was observed and expired on 06/11/22. LPA reviewed large family childcare home capacity limitations with licensees. LPA discussed SB 277 and SB 792 pertaining to immunization requirement for children and staff and advised Licensee to visit the licensing website at www.ccld.ca.gov for current forms, laws, regulations and legislation.

Report continued on subsequent page 809C----

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2020

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: MALONE, TIANDRA	FACILITY NUMBER: 343623429
	VISIT DATE: 06/12/2020

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
26
27
28
29
30
31
32

The Department received Fire Safety Inspection Clearance on 04/08/20, and home has been cleared for up to 14 children.

LPA provided to Licensee via email transmission the Safe Sleep in Child Care and the Effects of Lead Exposure brochures. LPA also emailed COVID-19 Posting documents, Use of Personal Protective Equipment during COVID-19 Outbreak guidance, COVID-19 Self-Assessment Guide, and PIN #20-06 guidance and practice regarding social and physical distance to prevent exposure to COVID-19.

As of today's date, facility is licensed 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 elementary school and 1 child at least age 6 with a maximum of 3 infants.

In lieu of Licensee's signature, LPA is e-mailing the report with a read receipt request to Licensee. Notice of Site Visit was email to Licensee. Notice of Site Visit should be posted in a conspicuous area for 30 days.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2