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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623605
Report Date: 07/22/2020
Date Signed: 07/22/2020 03:10:37 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:COLLINS, DOMINIQUEFACILITY NUMBER:
343623605
ADMINISTRATOR:COLLINS, DOMINIQUEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 283-3236
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:14CENSUS: 0DATE:
07/22/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Dominique Collins and Jalisa DayTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Elvira Sierra contacted Applicants Dominique N. Collins and Jalisa G. Day to conduct a prelicensing inspection. The applicants requested a license for a capacity of 14 children. Due to COVID-19 pandemic, LPA is conducting the meeting via FaceTime with the Applicants. During the FaceTime visit, LPA Sierra requested to tour the facility.

The facility will operate M-F from 07:00 AM to 06:00 PM. LPA advised that her own children count in the ratio until they reach 10 years of age. Applicants understands they must be present at the facility for 80% of operating hours. All adults living in the home have obtained criminal background clearance. Home is 3 bedrooms, and 2 bathrooms house. Applicants own the home and LPA observed proof of ownership.
LPA inspected the facility for health and safety hazards and the following was observed;

Off-limit areas will consist of; Master Bedroom, Bathroom # 2 (inside master bedroom), Bedroom # 3, Front yard, and Garage. Applicants plan to use gates as a barrier to prevent access to these areas and/or child proof knobs. Applicants understand that children may and never enter these off-limit areas. Safe toys and comfortable accommodations were observed. The fireplace in the living room is properly barricaded. Applicants stated there are no weapons in the home. Home has a 2: A10; BC fire extinguisher, a working smoke detector and carbon monoxide detector in the home. Cleaning compounds, poisons and hazardous materials are inaccessible to children. There are no bodies of water. LPA advised applicant that baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. It was discussed that fire drills must be conducted and documented at least every six months; LPA provided applicant with a Fire Drill Log.
The Applicants completed the preventative health and safety training which includes the nutrition training. CPR expires on 03/21. Applicants provided proof of Immunization's to meet SB792 and completed the mandatory child abuse training. LPA explained that training must be completed every two years (AB1207). Mandated Reporter Training expires on 05/22.
Report continue subsequent page 809C-----------
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2020
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: COLLINS, DOMINIQUE
FACILITY NUMBER: 343623605
VISIT DATE: 07/22/2020
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LPA discussed the smoking prohibition with the Applicants. Type A/B citations and Immediate Civil Penalty regulation deficiencies were reviewed. LPA also explained the Zero Tolerance and immediate Civil Penalty regulation deficiencies and citations.

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.

This facility evaluation report was reviewed and discussed. LIC 311D, records, postings, and reporting requirements were discussed. LPA discussed supervision, personal rights, criminal record clearances, staffing ratios and capacity, and maintaining buildings and grounds. Applicant was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes. LPA provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochures. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so applicants can request to be added to the distribution list to receive Quarterly Updates.

The Department received Fire Safety Inspection Clearance on 07/21/20 and home has been cleared for up to 14 children.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 Applicants signature, LPA is e-mailing the report with a read receipt request.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2020
LIC809 (FAS) - (06/04)
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