376100548-10-20-2020-51-CC-KLAE-BUKPH4-20201020111919

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100548
Report Date: 10/20/2020
Date Signed: 10/20/2020 11:20:19 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	NEDELJKOVIC, ANA FAMILY CHILD CARE		FACILITY NUMBER:	376100548
ADMINISTRATOR:	ANA NEDELJKOVIC		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(858) 699-3575
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92117
CAPACITY:	14	CENSUS: 0	DATE:	10/20/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ana Nedeljkovic		TIME COMPLETED:	11:15 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	On 10/20/20 at 10:00 AM, Licensing Program Analysts (LPAs) Keturah Lane and Patrick Ma conducted an announced Pre-Licensing tele-inspection due to COVID-19 for relocation with the applicant. LPA Lane and Ma met with applicant Ana Nedeljkovic via Zoom. Also present at the home were applicant’s husband and two children. The one-story home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Applicant made fireplace inaccessible by placing a shelf in front of it. There are no bodies of water in the home. Applicant states that there are no weapons in the home. CPR and First Aid expire on 11/4/2020 and applicant has an appointment for renewal on 10/24/20. Preventative Health course was completed 1/19/17 but applicant needs to complete the additional Lead Poisoning prevention training. Applicant plans to take the training on 10/28/20. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Staff immunization requirements were met. Applicant rents the home. Applicant will be using the following rooms for childcare: living room, kitchen and bathroom. Off-limits areas include: bedroom #1, bedroom #2, bedroom #3 and bathroom #2 and are inaccessible through the use of door knob covers. The garage will also be off limits and is kept inaccessible through the use door locks. The applicant has sufficient toys and equipment available. The home has a fenced backyard available for outdoor activities. There are minor gaps in the fence on the west side, but it does not appear to be a hazard. Applicant will monitor the situation regarding the fence. (Continued on LIC809C...)

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah Lane	TELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: NEDELJKOVIC, ANA FAMILY CHILD CARE	FACILITY NUMBER: 376100548
	VISIT DATE: 10/20/2020

NARRATIVE

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Applicant was reminded of requirements for children’s records, child abuse, and unusual incident reporting, immunizations, adults living or working in the home and associated civil penalties, applicant was also reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA provided information regarding Safe Sleep Regulations/SIDS and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty Crib on a firm mattress. LPA also reviewed COVID-19 guidelines and provided additional information regarding reporting positives/exposure incidents. Applicant completed the COVID-19 televisit with LPA Diaz on 9/1/20 at the previous facility location.

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.

Corrections needed:
1. Display required postings

Once corrections are sent via e-mail to LPA a provisional license for 8 children will be granted and expires in 30 days. Once applicant has completed the Lead Poisoning Prevention training and has e-mailed proof of certificate of completion to LPA, then LPA will grant a regular license.

An exit interview was conducted with applicant. A Notice of Site Visit (LIC9213) and Appeal Rights (LIC9058) will be sent along with the report (LIC809) via e-mail to the Licensee. Licensee will confirm receipt of this report via e-mail and the reply of confirmation will serve as the signature acknowledging these rights. The Notice of Site Visit (LIC9213) must remain posted for 30 days.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah Lane	TELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020

LIC809 (FAS) - (06/04)

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