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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100548
Report Date: 11/06/2020
Date Signed: 11/06/2020 09:30:44 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 CAREFACILITY NUMBER:
376100548
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
11/06/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Ana NedeljkovicTIME COMPLETED:
09:27 AM
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On 11/6/2020 at 9:10 AM Licensing Program Analyst (LPA) Keturah Lane, conducted an unannounced tele-inspection (COVID-19 State of Emergency) for a capacity increase with the applicant, Ana Nedeljkovic. A recent relocation inspection was conducted on 10/20/20 and there was one deficiency which was the required postings. Applicant submitted correction (picture of postings) to LPA Lane via e-mail later the same day (10/20/20). A provisional license was granted on 10/20/20 because the applicant needed to complete the Lead Poisoning Prevention training. The training was completed on 10/30/20. The applicant also renewed her CPR and First Aid and it expires 10/24/2022. Proof of corrections and requirements for the small family child care license at this new location are complete.

The applicant’s home appears to be large enough to comfortably accommodate 14 children in care. Fire clearance was granted on 11/5/20. Applicant has obtained landlord consent to care for 14 children. Children’s records were reviewed and found to be in order. There were 6 children in care at the time of the tele-inspection.

No deficiencies are cited. No corrections are needed; a license for 14 will be issued effective upon final file review.

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 CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2020
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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