343624065-8-30-2021-03-CC-KGUA-C6DQ88-20210830115619

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624065
Report Date: 08/30/2021
Date Signed: 08/30/2021 11:56:27 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:	KING, AJA		FACILITY NUMBER:	343624065
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	08/30/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Aja Bernard		TIME COMPLETED:	12:10 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	At 10:40 a.m. on Monday, August 30th, 2021, Licensing Program Analyst (LPA) Karyn Guerra met with Applicant, Aja Bernard, for the purpose of a prelicensing inspection for a change of location. A risk assessment for COVID-19 was conducted via telephone prior to entry into the facility. Licensee was previously licensed at facility #343623242. All individuals subject to criminal background review have obtained a criminal record clearance. Licensee’s own child and one unrelated child were also present during today’s inspection. The single story home facility consists of 3 bedrooms, 2 bathrooms, kitchen, living room, and garage. Off-limit areas consist of all bedrooms, Kitchen, Garage, and Left gated side of backyard. Applicant acknowledges that children must never enter the off-limits area. Hours of operation are 7:00AM-5:00PM, Monday thru Thursday, and 7:00AM-4:30PM Friday. Applicant understands she must be present at the facility for 80% of operating hours. LPA and Applicant toured the entire facility. Applicant plans to have an outdoor classroom but will be utilizing some spaces indoors. LPA observed functioning smoke and carbon monoxide detectors, and a 2A10-BC fire extinguisher. LPA reviewed the required postings. Applicant will be framing postings and placing them outdoors. Cleaning materials, hazardous items, and medications are all stored inaccessible to children. There are no bodies of water on the premises. Applicant understands that kiddie pool must never be left unattended when filled with water. There is wood in the backyard for slide construction. Applicant stated that it will be moved to the off limits portion of the yard until constructed. Applicant will provide photo of slide when slide construction is complete. Fireplace in the living room has a sliding lock mechanism. Applicant stated they will be purchasing a gate as well to place in front of fireplace. Applicant stated that there are no firearms in the home. Report Continues on 809-C.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

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: KING, AJA	FACILITY NUMBER: 343624065
	VISIT DATE: 08/30/2021

NARRATIVE

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Applicant rents the home. A copy of the rental agreement addendum was previously provided to show control of property. Owner/Landlord Notification form is on file with the department. Licensee has completed the required Preventative Health and Safety course which includes 1 hour of nutrition. Applicant has taken the supplemental lead prevention training. Applicant’s current in person EMSA approved CPR and First Aid certification was verified and expires on 7/24/2023. AB1207 Mandated Reporter training certification was verified and expires 7/27/2023.

LPA reviewed Safe Sleep regulations and COVID-19 industry guidance for child care. LPA did not observe a crib in the home. LPA discussed that if Licensee will be providing care to infants, there shall be one infant crib or play yard for each infant who is unable to climb out of the crib or play yard.

As of today 08/30/2021, facility is approved for a Small Family Child Care Home license for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2. LPA advised that the old facility number will be closed as of this date and she is no longer able to operate in that location.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

LIC809 (FAS) - (06/04)

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