376628231-7-12-2019-20-CC-JARL-BDZREX-20190712125817

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376628231
Report Date: 07/12/2019
Date Signed: 07/12/2019 12:58:22 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:	CARROLL, EURANIKA FAMILY CHILD CARE		FACILITY NUMBER:	376628231
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	07/12/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Euranika Carroll		TIME COMPLETED:	01:00 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) Jo Ann Legaspi conducted an unannounced capacity increase inspection. Licensee Euranika Carroll was advised of the meeting’s purpose and granted LPA facility entry. On 06/03/2019, Licensee submitted an application (LIC 279) requesting a capacity increase. The Fire Safety Inspection Request (STD 850) was approved by the local fire marshal on 06/26/2019 for fourteen (14) children. The home consists of two (2) stories with three (3) bedrooms, one (1) loft and two (2) bathrooms. The following rooms are to be used for daycare children: living room, dining room, art studio and fenced backyard. The off-limit areas are the bedrooms and upstairs. A safety gate was observed barricading the stairs. Licensee accompanied LPA on a tour of the home, as shown on the updated facility sketch. Background criminal record clearances were verified and discussed. Facility has working 2A10BC fire extinguisher, smoke alarms, carbon monoxide, and the first aid kit in place. The last safety drill was on 04/05/2019. There are no bodies of water on the premises. Per the Licensee, no weapons or ammunition are housed in the facility. LPA provided and reviewed with Licensee PIN 19-06-CCP, which states the US Consumer Product Safety Commission has issued a safety recall of specific sleepers due to a number of infant deaths. LPA provided and discussed with Licensee PIN 19-08-CCP, which describes new immunization requirements issued by the Department of Public Health. LPA further provided and discussed with Licensee PIN 19-07-CCP, which provides information regarding randon toxicity and free testing.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: CARROLL, EURANIKA FAMILY CHILD CARE	FACILITY NUMBER: 376628231
	VISIT DATE: 07/12/2019

NARRATIVE

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In the areas that were evaluated, no deficiencies were observed. Licensure for a capacity of fourteen (14) children is approved as of today's date, 07/12/2019. A new license will be generated and mailed to the provider.

LPA provided the Licensee with the Notice of Site Visit – LIC 9213, which is to be posted for thirty (30) days. LPA observed Licensee post this document.

An exit interview was conducted with the Licensee, who was provided a copy of this signed report and their Licensee Rights (LIC 9058 1/16). Their signature on this form acknowledges receipt of these rights.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019

LIC809 (FAS) - (06/04)

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