343623702-10-23-2020-03-CC-ESIA-BUNNLS-20201023103401

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623702
Report Date: 10/23/2020
Date Signed: 10/23/2020 10:34:28 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:	ELIX, MAYESHA		FACILITY NUMBER:	343623702
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	10/23/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Mayesha Elix		TIME COMPLETED:	10:00 AM

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NOTE: Due to Covid-19 and DPH guidelines on physical distancing, a Tele-visit via FaceTime was conducted. On Friday, October 23, 2020, at 8:00 AM, Licensing Program Analyst (LPA) Elvira Sierra conducted a Pre-Licensing inspection visit. The applicants requested a license for a capacity of 14 children. Hours of operation will be M-F 07:00 AM to 06:00 PM. Applicant understands she must be present at the facility for 80% of operating hours. All adults living in the home have obtained criminal background clearance. Home is a one story, three bedrooms, and two bathrooms house.

At 08:15 AM, with the help of the applicant, a health and safety inspection of all areas accessible to children was conducted and the following was observed; The Off-limits areas will consist of; Living Room, Office Room (Room 1), Home Nursery Room (Room 2) Master Bedroom (Room 3), Bathroom 2 (inside master bedroom), Front Yard and Garage. Licensee acknowledged that children may never enter these off-limit areas. Applicant acknowledge that she is required to notify licensing prior to making changes to off-limit areas. Safe toys and comfortable accommodations were observed. Home has a fireplace that is properly barricaded. Cleaning compounds, poisons and hazardous materials are inaccessible to children. Applicant acknowledges poisons are to be locked under lock and key or combination lock while day care children are present. Home was observed having a 2A:10-B:C fire extinguisher, a working telephone and smoke and carbon monoxide detector. There are no bodies of water on the premises. Per applicant there are no weapons in the home. Outdoor play area is fenced for supervision and is free from defects or dangerous conditions. Applicant understands children must have on-site supervision in unfenced areas and during water activities. Day-care children may never be left alone with minors and adults providing care and supervision are to obtain criminal record clearances prior to working or living in the home.

Applicant stated that she won’t transport children. Applicant rents the home and LPA observed proof of lease agreement. Applicant have obtained liability insurance for the daycare. LPA discussed the smoking prohibition with the Applicant. 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.

Report continue 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: 10/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2020

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: ELIX, MAYESHA	FACILITY NUMBER: 343623702
	VISIT DATE: 10/23/2020

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LPA advised applicant that baby walkers, bouncers, jumpers, and similar items are not allowed in a Family Child Care Home. It was discussed that fire drills must be conducted and documented at least every six months; LPA provided applicant with a Fire Drill log. Applicant completed the preventative health and safety training which includes the nutrition training and instructions of the prevention on lead exposure. CPR expires on 08/22. The Applicant provided proof of Immunization's to meet SB792 and completed the mandatory child abuse training and expires on 09/07/2022. LPA explained that training must be completed every two years (AB1207).

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.

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 applicant can request to be added to the distribution list to receive Quarterly Updates.

*LPA discussed guidance and practices regarding social and physical distancing for providers to prevent exposure to COVID-19 while providing care for children. COVID-19 Posting documents and the use of Personal Protective Equipment during COVID-19 Outbreak guidance were provided.

Fire Safety Inspection Clearance was granted on 10/20/20 and home has been cleared for up to 14 children.

Report continues on subsuquent page 809C-----

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2020

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: ELIX, MAYESHA	FACILITY NUMBER: 343623702
	VISIT DATE: 10/23/2020

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Effective today, 10/23/20, this home is licensed for a Large Family Child Care License 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 above and 1 child at least age 6 with a maximum of 3 infants

Facility evaluation report was emailed to Licensee and an email verification of receipt of report will be used in lieu of a signature on this report.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2020

LIC809 (FAS) - (06/04)

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