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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624065
Report Date: 10/18/2021
Date Signed: 10/18/2021 10:20:24 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, AJAFACILITY NUMBER:
343624065
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
10/18/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Aja King - LicenseeTIME COMPLETED:
10:35 AM
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On Monday, October 18th, 2021, at 9:41am, Licensing Program Analyst (LPA) Blake Morillas conducted a Case Management visit for the purpose of increasing capacity from 8 to 14 children. At 9:42am LPA informed the Licensee, Aja King, of the reason for the inspection. At 9:42am, 1 infants and 4 preschool age children were observed along with the Licensee. Licensee stated there are no new residents in the home. Adult residents have criminal record clearances.

The Fire Safety Inspection Clearance has been received from the local Fire Department and the home has been cleared for up to 14 children.

At 9:48am, LPA initiated a health and safety inspection of all areas accessible to children.

Off-limits areas include the Garage, Kitchen, All Bedrooms, and Side Yard. Licensee acknowledged that children may never enter these off-limit areas.

LPA observed current CPR/First Aid certificates (expires: 7/2023), posted License, Parent's Rights and current emergency disaster plan. A current roster of the enrolled children and fire drill log was observed.

Hazardous items were stored inaccessible to children in care. Licensee stated there are no weapons in the home.

Fire extinguisher (2A10BC), carbon monoxide and smoke detector meet regulation. Toys appear to be safe. The backyard is fenced. There are no bodies of water on the premises.

Continued on LIC 809-C
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021
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: 10/18/2021
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Contined from LIC 809

Licensee understands that prior to making alterations or additions to the home or grounds, the Licensee shall notify the Department of the proposed changes.

LPA provided and discussed the Safe Sleep in Child Care regulations as well as current Covid-19 guidelines.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.



Capacity increase is approved as of 10/18/2021.

The facility is licensed to serve a MAX. CAP(WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

At 10:15am, LPA reviewed and discussed this facility evaluation report with the Licensee.

Notice of site visit posted.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021
LIC809 (FAS) - (06/04)
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