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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622149
Report Date: 09/04/2020
Date Signed: 09/04/2020 04:01:58 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:TYSON, ANGELAFACILITY NUMBER:
393622149
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 8DATE:
09/04/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Angela TysonTIME COMPLETED:
03:45 PM
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Due to COVID-19 pandemic, Licensing Program Analyst (LPA) Christopher Jackson is conducting a tele-video inspection via Zoom with the Applicant Angela Tyson. The purpose of today's inspection is to conduct a change of capacity Tele-inspection. Licensee has applied for a large family home day-care license. Also present at the home during today's inspection was applicants husband. All adult individuals have obtained a criminal record clearance and are cleared through the department.

LPA conducted a virtual tour of the home with the Licensee. The home has two stories. The downstairs consists of a kitchen, family room, living room, dining room, restroom, and laundry room. The second floor consists of four bedrooms and two bathrooms . Off-limit area include: Entire second floor, laundry room and garage. Licensee acknowledged that children may never enter these off-limit areas. Fire clearance has been approved by the Stockton Fire Department on 08/19/2020. Licensee stated there are no new residents in the home since licensure. During today's inspection LPA discussed large family child care home capacity limitations with licensee. LPA provided capacity breakdown worksheet for licensee.

LPA observed cleaning supplies to be properly stored out of reach of children. LPA observed the gate at the bottom of the stairs to be properly barricaded. Licensee stated there are no weapons in the home. LPA observed fire extinguishers, functioning smoke detector, and functioning carbon monoxide in the home. LPA discussed that the licensee must conduct a fire drill at least once every six months. LPA observed the backyard is fully fenced in with play equipment and toys for children in care. LPA discussed with licensee that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes. LPA observed a current CPR/First Aid certificate Exp 12/2021. LPA advised licensee to visit the licensing website at http://www.ccld.ca.gov for current forms, laws, regulations and legislation.

Effective today 09/04/2020, LPA is granting a large family child care license to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when, 1 child is enrolled in Transitional kindergarten or above and 1 child at least age 6 with a maximum of 3 infants. Infants are children under the age of 2 years old.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher JacksonTELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2020
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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