343624027-8-26-2021-03-CC-JHOA-C69TAT-20210826143404

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624027
Report Date: 08/26/2021
Date Signed: 08/26/2021 02:34:17 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:	BLAKESLEE, TALINA		FACILITY NUMBER:	343624027
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	08/26/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Taline Blakeslee		TIME COMPLETED:	02:50 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	On Thursday, 08/26/21 at 12:15pm, Licensing Program Analyst (LPA) Jan Hoshida met with Licensee Talina Blakeslee for the purpose of a change of location pre-licensing inspection. LPA observed there were no day care children present during the inspection. The one-story home has an unfenced front yard, four bedrooms, two bathrooms, kitchen with attached dining room that shares the living room, playroom, laundry room, and fenced backyard with a pool. The off-limit areas include all four bedrooms and the master bathroom. Licensee acknowledged that day care children may never enter these off-limit areas. All adult residents have criminal record clearances. The hours of operation will be Tuesdays, Wednesdays, and Thursdays from 8:30am to 12:30pm. LPA and Licensee conducted a health and safety inside and out the home. A functioning smoke and carbon monoxide detector and fire extinguisher were observed in the home. LPA observed that there were no hazardous items accessible to children. Licensee stated that she understands that any poisons must be kept under lock and key. LPA observed that cleaning materials were inaccessible. Licensee stated there are no weapons in the home. Toys appear to be safe. Current pediatric CPR and first aid training expires on 8/2023. Mandated Reporter training is on file and was taken on 02/03/21. LPA observed the fireplace which was screened. The backyard is fenced and gated. Licensee has the required Licensing forms posted near the parent entrance in the side yard area. Licensee stated that the majority of her day care time will be spent outdoors, therefore wanted the Licensing forms in the area where the parents will be dropping off their children. Licensee stated that they will be building a detached garage/pool room with a bathroom in October 2021. Licensee stated that she understands that CCL must inspect the new area prior to children using the space. *REPORT CONTINUED ON NEXT PAGE*

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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: BLAKESLEE, TALINA	FACILITY NUMBER: 343624027
	VISIT DATE: 08/26/2021

NARRATIVE

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There is an in-ground pool on the property which is completely surrounded by a see-through mesh fence that is four feet and 10 and a half inches high. LPA observed the gate to self-close and self-latch. There are no windows or doors that provide direct access into the pool area. Licensee stated that she will adjust the pool fencing to meet the height requirement to be at least five feet tall for all areas around the pool.

LPA observed in the front yard there was a pile of wood boards that had nails protruding from the wood. Licensee stated that the children do not play in that area and she will get rid of the nails and wood.

LPA provided Applicant with Safe Sleep PIN 20-24-CCP, reviewed Infant Individual Sleeping Plan (LIC 9227) for children under 12 months, and sleep logs for the children under two years of age. LPA discussed current COVID-19 child care guidelines with Applicant.

This facility plan to provide Incidental Medical Services- IMS. 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 with the Licensee. Records, postings and reporting requirements were discussed. Licensee was encouraged to visit the department website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, self-assessment guides, regulations and legislation pertaining to family child care homes. LPA also included the email address for the children's advocacy program to stay current on new laws CHILDCAREADVOCATESPROGRAM@DSS.CA.GOV.

The following to be submitted prior to licensure:
· Proof of pool fencing to be at least five feet high surrounding the entire pool area.

REPORT CONTINUED ON NEXT PAGE

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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: BLAKESLEE, TALINA	FACILITY NUMBER: 343624027
	VISIT DATE: 08/26/2021

NARRATIVE

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After proof of pool fencing that is at least five feet high surrounding the entire pool area, facility will be approved for a Small Family Child Care home license to serve a capacity of 6 children with no more than 3 infants or 4 infants only. Or with a capacity of 8 children with landlord consent: no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6. An exit interview was conducted and Notice of Site Visit was provided to be posted for 30 days.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

LIC809 (FAS) - (06/04)

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