483009502-8-5-2019-01-CC-MAUN-BERMRM-20190805095033

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483009502
Report Date: 08/05/2019
Date Signed: 08/05/2019 09:51:00 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME:	JOHNSON, JENIQUE FCCH		FACILITY NUMBER:	483009502
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	08/05/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	08:05 AM
MET WITH:	Jenique Johnson		TIME COMPLETED:	10:05 AM

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	A Case Management inspection was made to the facility by Licensing Program Analyst (LPA), Melchisedeck Augustin. The Licensee submitted an application to increase the facility's capacity from 8 to 14. On 07/29/19, the Vallejo Fire Department conducted a fire safety inspection and the facility was granted a fire clearance to operate at a capacity of 14. A review of staff records on 08/05/19 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There is currently one adult living in the home. During today’s inspection the home and grounds were toured. The licensee was supervising six children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are 7:00am to 9:00pm, Mon–Sun. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are three bedrooms, one bathroom and the garage, and were made inaccessible by plastic door knob covers. The home was clean and orderly, and was at a comfortable indoor temperature of 70 degrees Fahrenheit. There is a working telephone in the home. The licensee has current pediatric CPR and First Aid certification, which expire on 01/2020. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were stored out of the reach of children. LPA did not observe any poisons. The fireplace has been made inaccessible by a large cardboard cut out and various children's toy structures. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee has a current roster of children in care. The licensee has conducted an emergency drill within the past six months, last drill was conducted on 08/05/19. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection. The children use the backyard as the outdoor play area and it is fully fenced. There were no pools or bodies of water observed in the yard. The licensee is not providing Incidental Medical Services (IMS) to children in care. The Incidental Medical Services (IMS) policy was discussed with the licensee. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2019

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: JOHNSON, JENIQUE FCCH	FACILITY NUMBER: 483009502
	VISIT DATE: 08/05/2019

NARRATIVE

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When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.
The following information regarding ADA was provided: US Department of Justice toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection. The following needs to be completed prior to the granting of license to operate as a Large Family Child Care Home. Please include facility number in all correspondence.
1. One adult on the facility personnel report summary must obtain criminal record clearance.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2019

LIC809 (FAS) - (06/04)

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