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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002043
Report Date: 03/11/2020
Date Signed: 03/11/2020 11:12:42 AM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:FELLOM, JULIE ANNAFACILITY NUMBER:
384002043
ADMINISTRATOR:FELLOM, JULIE ANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 971-4963
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94114
CAPACITY:14CENSUS: 4DATE:
03/11/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Michelle Azevedo and Noe VenadleTIME COMPLETED:
11:15 AM
NARRATIVE
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On March 11, 2020, at 8:45 am, Licensing Program Analyst (LPA), Van conducted an unannounced annual inspection and met with Michelle Azevedo and Noe Venadle. Ms. Venadle is the parent of a child that is attending the daycare. Ms. Venadle states, she also volunteered her time to teach music twice a month at the daycare, and the children that attending her class are not part of Julie Fellom's licensed capacity. Per Ms. Venadle, when she has her music class, Julie Fellom's children are on hiking. The purpose of the inspection was explained and granted entry to the home by the staff. Present, there are no children, staff states the children are on a field trip and will be back around 11:30 am. All adults living or working in the home have a criminal background clearance on file. The house is a 3-floor building; Licensee's partner owns this building. Daycare areas are: a small kitchen area, bathroom, and the backyard on the lower level; the activity room is on the street level, and the playroom in the lowest level and has direct access to the back yard for outdoor activity. The off-limit areas are the entire top floor level, the storage, kitchen, and the garage on the street level. The Days and operation hours are 8:30 am – 5:30 pm, Monday – Friday. Per staff, sick children will be separated from the group and will be waited in the activity room for the parent to pick up.

At 9:10 am, LPA, along with the staff, inspected the daycare areas for health and safety hazards. LPA observed the following: The daycare area is clean and orderly, and has adequate lighting and ventilation. The home has a working telephone, a working smoke, a carbon monoxide detector, a fully charged fire extinguisher, and First aid supplies. Per staff, there are no firearms or other dangerous weapons in the home. The staff states there are three dogs on the premises, and dogs are situated in the off-limit area and had up to date vaccinations. LPA observed no pools, spas, hot tubs, fish ponds, or similar bodies of water in the home. Fireplaces are screened to prevent access by children. The home provides safe toys, play equipment, and materials. LPA observed cleaning compounds, detergents, and other items that could pose a danger to children are stored inaccessible to children. The backyard equipment is in good condition, free of sharp, loose, or pointed parts, and space is maintained in a safe condition. LPA observed Licensee had posted all the required forms (i.e., License, Notification of Parent's Rights, and Emergency Disaster Plan). Per Licensee, fire drills are conducted every six months, and a record of the drill was documented accordingly.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2020
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: FELLOM, JULIE ANNA
FACILITY NUMBER: 384002043
VISIT DATE: 03/11/2020
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During the report writing, at approximately 10:00 am, four parents and four children arrived to attend Ms. Venadle class. LPA observed singing; parents and children sing along, and there are activities for the children as well.

LPA discussed the following with the staff. The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPA reviewed AB 1207 with the Licensee. As of January 1, 2018, all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Also, the Licensee was given information regarding 'Safe Sleep' practices. Furthermore, LPA discussed the Family Child Care Home checklist with the staff and provided to the staff the checklist as a reference for future inspection.

No deficiencies were observed in today's inspection. A copy of this report was reviewed and provided to the Licensee. This report will be kept in the facility file and will be made available for public review upon request. Notice of Site Visit was observed to be posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2020
LIC809 (FAS) - (06/04)
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