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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500387
Report Date: 04/09/2021
Date Signed: 04/16/2021 12:31:36 PM

Document Has Been Signed on 04/16/2021 12:31 PM - It Cannot Be Edited

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:MCCRAY, TATIANAFACILITY NUMBER:
394500387
ADMINISTRATOR:MCCRAY, TATIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 351-6677
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/09/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Tatiana MccrayTIME COMPLETED:
03:00 PM
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NOTE: Due to Covid-19 and DPH guidelines on physical distancing, a Tele-visit via FaceTime was conducted. On Friday, April 09, 2021, at 01:30PM, Licensing Program Analyst (LPA) Elvira Sierra conducted a Prelicensing visit for the purpose of change of location. Applicant was previously license under facility #.393620832. LPA explained about obtaining $300,000 liability insurance. Facility hours of operation will be M-F from 07:00 AM to 07:00 PM. All individuals residing in the home have obtained a criminal record clearance. No children were present at the new home. Fire clearance was granted for a capacity of 14 children and approved on 04/06/21.

At 01:45 PM, with the help of the Applicant, a health and safety inspection was conducted and the following was observed. Home is a 4 bedrooms and 2 bathroom. The Off-limits areas include; All Bedrooms, Bathroom # 2 (inside master bedrrom), Garage, front yard and driveway. Applicant acknowledged that children may never enter these off-limit areas. Aplicant has a current CPR that expires on 08/24/21. Mandated Reporter Training expires on 11/30/20, applicant understands that the training must be updated every 2 years. The fireplace in the living room has been properly barricaded. Fire extinguisher (2A10BC), carbon monoxide and smoke detector meet regulation. The backyard is fenced for supervision. Applicant understands that in unfenced area’s 100% supervision of children is required. There are no bodies of water on the premises. Applicant was advised that prior to making alterations or additions to the home or grounds, the applicant shall notify the Department of the proposed changes. Proof of control of property will be submit to the Department.

LPA received self-assessment guide and uploaded attachment to FAS. LPA confirmed COVID-19 posters have been displayed at the entry of the home with the parents rights poster. The emergency disaster plan has been updated to reflect Health Department contact information and is posted on the entrance of the home.

Report continues on page 809C----
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 04/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2021
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: MCCRAY, TATIANA
FACILITY NUMBER: 394500387
VISIT DATE: 04/09/2021
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LPA provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochures. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so applicant can request to be added to the distribution list to receive Quarterly Updates.

*LPA discussed guidance and practices regarding social and physical distancing for providers to prevent exposure to COVID-19 while providing care for children. COVID-19 Posting documents and the use of Personal Protective Equipment during COVID-19 Outbreak guidance*.



License will be granted upon correcting the following:
-Outdoor play area does not have enough tanbark or any type or cushioning, especially in the areas under and around the climbing equipment in the backyard.
-Need to show manufacture level or proof that the play structure in the backyard is age appropriate for the children in care.(if play structure will be off limits, applicant will have to create a barrier so children won't be able to access that side of the backyard.
-Install gates on both right and left side of the house if off limits or removed all tool from the area.
-Equipped the home with napping equipment and age appropriate toys
-Install gates or barriers in areas that will be inaccessible to children.
-Install child proof locks on cabinets where any hazardous items will be storage.


Second inspection will be schedule to confirm corrections. Facility evaluation report was emailed to applicant and an email verification of receipt of report will be used in lieu of a signature on this report.** Please note: When a physical inspection takes place, requests for alterations may be made**
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2021
LIC809 (FAS) - (06/04)
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