343623605-7-9-2021-03-CC-GSIH-C4RUJW-20210709153813

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623605
Report Date: 07/09/2021
Date Signed: 07/09/2021 03:38:18 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, DOMINIQUE & DAY, JALISA		FACILITY NUMBER:	343623605
ADMINISTRATOR:	COLLINS D/DAY JALISA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 283-3236
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95823
CAPACITY:	14	CENSUS: 11	DATE:	07/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Jalisa Day & Dominique Collins		TIME COMPLETED:	03:45 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	Licensing Program Analyst (LPA) Gagandeep Singh met with both licensee, Jalisa Day & Dominique Collins, for an annual inspection. The purpose of the inspection was explained. Licensee lives in a single story home. Present, there are 11 children ( including licensee’s own two children) in care with both of the licensees. All adults living or working in the home have criminal background check on file. Licensee is operating within the capacity of this date. Licensee provides day care from Monday to Friday between 7 AM to 6 PM. LPA inspected the day care areas with the licensee. Day Care Areas: Living room, Kitchen, Bathroom in Hallway, Bedroom # 1 and Backyard. Off limit areas: Master Bedroom, Bathroom in Master bedroom, Bedroom # 3 and Garage. There is no pool, spa or any other body of water in the house. As per licensee, there is no firearm or weapon in the house. All the cleaning supplies, poisons and other chemicals are stored inaccessible to the children. The house is in good repair and free of hazards with proper temperature and ventilation. There is carbon monoxide detector, fully charged fire extinguisher, working telephone and multiple smoke detectors available in the house. There is a variety of age appropriate toys in the house. Fireplace is barricaded. There are multiple play structures in the backyard. The air conditioning unit has been covered with net. LPA advised the licensee to have the backyard fence repaired. Per licensee, repair has been scheduled already. During the inspection, LPA review the facility record. LPA observed facility has all of the required documents posted and visible for public. Licensee also has COVID-19 precaution posters posted at different location in the house. LPA reviewed the identification and emergency information form for every child for proper names and numbers filled. Licensee has record of children’s immunization on file. LPA observed the infant’s needs and service plan and sleeping log for both of the infants present today. Licensee has well maintained children roster on file. See next page for continuation .................

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021

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 & DAY, JALISA	FACILITY NUMBER: 343623605
	VISIT DATE: 07/09/2021

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Both of the licensees have record of training of preventive health and CPR card valid until April 2021. Licensees are aware that the fire or emergency drills must be conducted at least once every six months and drills must be logged. LPA observed licensee has a log in place and per log, last drill was conducted on June 01, 2021. LPA discussed the infant sleep regulations and provided the copy of PIN 20-24-CCP.

Licensee is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Both of the licensee have completed the training and is valid until April 2021.

LPA encourage the licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

No deficiencies are cited today. The copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021

LIC809 (FAS) - (06/04)

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