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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393605184
Report Date: 06/12/2019
Date Signed: 06/12/2019 12:46:38 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:JOLAGH, SUSANFACILITY NUMBER:
393605184
ADMINISTRATOR:JOLAGH, SUSANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 952-5331
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY:14CENSUS: 3DATE:
06/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Susan JolaghTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Charlotte Baney met with licensee Susan Jolagh for an unannounced annual inspection. The facility operations Monday-Friday from 7:30am-6:00pm. LPA toured all areas of the home that are accessible to the children and observed care and supervision, a current roster of children, capacity and ratio. Today’s census was 3 children. LPA confirmed that all adult residents residing or working in the home have criminal record clearances. LPA advised licensee if anyone over the age of 18 years old moves into the home they must have a criminal record clearance as well. LPA observed posting of the license, Parent's Rights and the current disaster plan.
Off-limit areas include upstairs and half backyard; Licensee acknowledged that children may never enter these off-limit areas. The backyard is fenced and licensee acknowledges that children may never be left unsupervised in an unfenced area of the yard. There are no bodies of water on the property and licensee stated there are no weapons in the home.
LPA observed current CPR and First Aid certificates that expires on 5/21. LPA observed that poisons are locked and that fire extinguisher, smoke detector and carbon monoxide detector meets regulation. Cleaning materials, hazardous items and medications are all inaccessible to children. LPA observed a Fire Drill Log and the licensee is conducting fire drills at least every six months. There is a working telephone, toys appear to be in a safe condition and the home appears to be clean and orderly.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Charlotte BaneyTELEPHONE: (916) 216-7791
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019
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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