376100548-10-27-2021-51-CC-JLOT-C87SYV-20211027141809

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100548
Report Date: 10/27/2021
Date Signed: 10/27/2021 02:18:18 PM

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: 8	DATE:	10/27/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:26 AM
MET WITH:	Licensee, Ana Nedeljkovic		TIME COMPLETED:	01:05 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	Licensing Program Analyst (LPA), Jennifer Lott conducted an unannounced Annual Licensing Inspection. LPA was greeted at the front door by Licensee, Ana Nedeljkovic and granted entry after identifying herself and disclosing the purpose of her visit. Currently in care were 8 children, 2 of whom were infants. The licensee is using the following areas for daycare: Living room, kitchen, bathroom #1 and backyard. Off limit areas include: Bedrooms 1-3, bathroom #2, garage, front yard. Business Hours are: 8am-530pm Monday through Friday. Licensee provided a copy of their current roster and is operating within the licensed ratio and capacity. At 11:00 am LPA/Licensee tested the carbon monoxide/smoke detector located in the entry hallway. Both devices were functional. There are no bodies of water and no weapons or ammunition on the premises. Fireplaces was screened to prevent access by children. There are no stairs in the home. Storage for poisons, detergents, cleaning solutions, medications are locked and inaccessible to children. Outdoor play area is fenced and free of hazards. The last disaster/fire drill was conducted on 09/20/2021. The home is kept clean and orderly with heating and ventilation for safety and comfort. The home provides safe toys, play equipment and materials. Children’s records contained emergency contact information and immunization records. All parents or representatives received a copy of the Family Child Care Home Notification of Parent’s Rights. Pediatric CPR and First Aid cards are current and will expire on 10/24/2022. Mandated Child Abuse Reporting is waived as licensee's primary language is Serbian. Staff immunizations were reviewed and are in compliance. There is a working telephone and email address.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 629-8413
LICENSING EVALUATOR NAME: Jennifer Lott	TELEPHONE: 619-782-8300
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: NEDELJKOVIC, ANA FAMILY CHILD CARE	FACILITY NUMBER: 376100548
	VISIT DATE: 10/27/2021

NARRATIVE

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Licensee Nedeljkovic was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day / per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee Nedeljkovic and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee for facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to: inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Based on today’s visit, no deficiencies were observed at this time. Exit interview conducted and report was reviewed with licensee, Nedeljkovic. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 629-8413
LICENSING EVALUATOR NAME: Jennifer Lott	TELEPHONE: 619-782-8300
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021

LIC809 (FAS) - (06/04)

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