344500040-8-20-2019-53-CC-ASIA-BF8MJN-20190820093925

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 344500040
Report Date: 08/20/2019
Date Signed: 08/20/2019 09:39:31 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:	HARRIS-POTCH, JILLIAN		FACILITY NUMBER:	344500040
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	08/20/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Jillian Harris-Potch		TIME COMPLETED:	09:50 AM

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 Analysts (LPAs) Amy Silva and Marissa Soto met with the Licensee Jillian Harris-Potch. The purpose of today's inspection was for a capacity increase from a small family child care home with a maximum capacity of 8 children to a large family child care home with a maximum capacity of 14 children. Also present at today's inspection was Assistant, Molly Harris-Potch. LPAs toured all areas of the home that are accessible to children, today’s census included 6 children. The off-limits areas are; the master bedroom and master bathroom, kitchen, living room, laundry room, bathroom located in the back left of the home, garage, shed and the left side of the backyard. LPAs observed a current roster of the enrolled children and a fire drill log. LPAs observed current CPR/First Aid certificates and Mandated Reporter training. The Fire Safety Inspection Clearance has been received from the Fire department and the home has been cleared for up to 14 children. Licensee acknowledges that when there is no assistant present, facility will revert back to the requirements for a small family child care home. Licensee acknowledges that children residing in the home under the age of 10 years shall be included in capacity. 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. Report continued on 809C

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2019

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: HARRIS-POTCH, JILLIAN	FACILITY NUMBER: 344500040
	VISIT DATE: 08/20/2019

NARRATIVE

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

Effective today 8/20/19, LPAs are granting the Licensee, Jillian-Harris Potch, a license to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children with 1 child in kindergarten or elementary school and 1 child at least age 6 with no more than a maximum of 3 infants. Infants are children under the age of 2 years old.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2019

LIC809 (FAS) - (06/04)

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