343623702-8-20-2021-03-CC-GSIH-C63TDM-20210820143835

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623702
Report Date: 08/20/2021
Date Signed: 08/20/2021 02:38:40 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:	ELIX, MAYESHA		FACILITY NUMBER:	343623702
ADMINISTRATOR:	ELIX, MAYESHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 743-2129
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95826
CAPACITY:	14	CENSUS: 13	DATE:	08/20/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Mayesha Elix		TIME COMPLETED:	02:45 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 licensee, Mayesha Elix, for an annual inspection. The purpose of the inspection was explained. Licensee lives in a single story home. Present, there are 13 children (one infant, 12 pre school age) in care with licensee and two helpers. All adults have criminal background clearance on file. 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, Study room, Kitchen, Dinning area, Family room, Hallway, Bathroom in hallway and Backyard. Off limit areas: All bedrooms and Garage. All off limit rooms doorknobs have child protective covers installed to prevent any child have access. 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, smoke detector, fully charged fire extinguisher and working telephone available in the house. There is a variety of age appropriate toys in the house. All unused electrical outlets have child protective covers installed. LPA reviewed the facility records. LPA observed licensee has License and other required documents posted in the child care areas. Licensee has record of training of preventive health and CPR card valid until August 2022. LPA remind the licensee to conduct the fire or emergency drills at least once every six months and drills must be logged. LPA also reviewed the present children's record. LPA observed licensee has the identification and emergency information form for every child in care. LPA discussed the safe sleep regulations and provided the copy of PIN 20-24-CCP and Infant sleeping plan. 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: 08/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021

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: ELIX, MAYESHA	FACILITY NUMBER: 343623702
	VISIT DATE: 08/20/2021

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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. LPA observed licensee has completion certificate on file and per certificate, the training was conducted in August 2020.

LPA reminded the licensee that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles. The Department has the record of licensee’s required immunization on file.

LPA reminded the licensee that all adults, 18 years and older living in the home, helper or assistant must have criminal record clearance and must be associated to the facility by submitting an LIC 9182 with copy of CA DL or CA ID prior to having any contact with children in care. Failure to do so could result in an immediate civil penalty of $100.00 each day.

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 and civil penalties assessed. 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: 08/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021

LIC809 (FAS) - (06/04)

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