376629006-12-18-2020-20-CC-DSAZ-BWEUMB-20201218144205

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376629006
Report Date: 12/18/2020
Date Signed: 12/18/2020 02:43:31 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:	GOLDSBERRY, LEEZLY FAMILY CHILD CARE		FACILITY NUMBER:	376629006
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	12/18/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Leezly Goldsberry, Provider		TIME COMPLETED:	02:40 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) Diana Sanchez, conducted a Case Management inspection via video conference (FaceTime), due to the COVID-19 state of emergency. LPA video connect with Applicant Leezly Goldsberry, who was advised of the purpose of today's inspection is in response to the increase of capacity request to obtain a large license. The two story three bedroom home was virtually toured and inspected to ensure an environment safe for the care and supervision of children. The stairs were properly barricaded. Daycare areas includes: living room, dining room, kitchen, hallway bathroom and back yard. Off limits areas includes: All areas and bedrooms located on the second floor and garage. LPA noticed that all required notices, License and forms were properly posted. The house smoke and carbon monoxide detectors are operable and fire extinguisher is fully charged. The day care bathroom was inspected; the toilet and faucets are operational. The kitchen drawers are secured and chemicals are not accessible to children. A review of all adults living in this home who require caregiver background checks have received criminal record and child abuse clearances or exemptions. First Aid and CPR are up to date. Provider stated that they do not have hand gun or ammunition in this house. Per new Senate Bill 792 pertaining to immunizations, which require all adults in daycare operation to have proof of immunizations for; Measles, Pertussis or Whooping Cough and Influenza or Flu, LPA has verified that licensee has verification of required immunizations and is in compliance. Assembly Bill 1207 Mandated Child Abuse Reporting. Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Diana Sanchez	TELEPHONE: (619) 767- 2210
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2020

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: GOLDSBERRY, LEEZLY FAMILY CHILD CARE	FACILITY NUMBER: 376629006
	VISIT DATE: 12/18/2020

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The maximum number of children for whom care shall be provided when there is an assistant provider in the home, including children under age 10 who live in the licensee's home and the assistant provider's children under age 10, shall be either: Twelve (12) children with no more than four of whom may be infants or Fourteen (14) children, at least two of the children are at least six years of age and no more than three infants with landlord consent.

A provisional large license is granted on this date. This license is effective 12/18/2020 to 2/10/2021. Mrs. Goldsberry shall complete the Preventative Health course, including the one hour nutrition as required by law, no later than 2/10/2021.

LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

Community Care Licensing WEB SITE: http://www.ccld.ca.gov

No deficiencies were cited during today's inspection. An exit interview was conducted with Leezly Goldsberry and a copy of this report will be emailed. Applicant was advised that acknowledgement and receipt of the report is to be received within twenty-four hours.

NOTICE OF SITE VISIT MUST BE POSTED FOR 30 DAYS

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Diana Sanchez	TELEPHONE: (619) 767- 2210
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2020

LIC809 (FAS) - (06/04)

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