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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623560
Report Date: 06/08/2020
Date Signed: 06/08/2020 02:42:01 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:PARKER, LAKIAFACILITY NUMBER:
343623560
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
06/08/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lakia Parker, ApplicantTIME COMPLETED:
02:45 PM
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Due to COVID-19 pandemic, Licensing Program Analyst (LPA) Joleen Kenney is conducting the meeting via FaceTime with the Applicant.

LPA Kenney contacted the Applicant, Lakia Parker, for the purpose of a pre-licensing inspection for a small family child care home. During the FaceTime visit, LPA Kenney requested to tour the facility. LPA and Applicant toured the four story home which consists of 3 bedrooms, 3 bathrooms, living room, kitchen, laundry room, garage and patio. Off limit area will consist of the entire upstairs. The applicant understands that children are not allowed access to off limit areas.

LPA obtained a copy of the Rental Agreement from the Applicant as proof of control of property. Applicant has not completed the Preventative Health and Safety course which includes 1 hour of nutrition but is in the process of scheduling the class. The Applicant has provided a current Pediatric First aid and CPR training certificate that will expire 11/2021. LPA provided blank forms required for children's records including immunization card and proposed Safe Sleep Regulation Concepts. LPA provided documents for 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.

(report continued on next page, LIC809C)
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen KenneyTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2020
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: PARKER, LAKIA
FACILITY NUMBER: 343623560
VISIT DATE: 06/08/2020
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There is a community pool in the complex that is secured with a fence and gate. Applicant stated that there are no weapons in the home. Cleaning compounds, knives and medications are inaccessible to children. LPA observed a 2A10BC fire extinguisher, an operational smoke and carbon monoxide detector in the home that meet regulatory standards. 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. The Mandated Reporter training has been completed. The applicant understand that the Mandated Reporter training must be renewed every two years and is accessible at www.mandatedreporterca.com. Applicant understands that a current children's 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 that if the applicant 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 changes are made to the off limit areas to include as on limits; licensing must be notified prior to allowing children access to those areas.

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.

Effective today, June 8, 2020, a provisional license 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. This provisional license shall expire 90 days after the date of issuance. The provisional license will be changed to a regular license once the Preventative Health Training is available and a certificate of completion is provided.
In lieu of Licensee's signature, LPA Kenney is e-mailing the report with a read receipt request.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen KenneyTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2020
LIC809 (FAS) - (06/04)
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