483009725-6-28-2019-01-CC-MAUN-BDKUJ2-20190628153650

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483009725
Report Date: 06/28/2019
Date Signed: 06/28/2019 03:36:56 PM

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:	BRAZEEL, ANGELA FCCH		FACILITY NUMBER:	483009725
ADMINISTRATOR:	BRAZEEL, ANGELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 389-1600
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY:	14	CENSUS: 0	DATE:	06/28/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Angela Brazeel		TIME COMPLETED:	03:45 PM

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 prelicensing inspection visit was conducted today by Licensing Program Analyst (LPA), Melchisedeck Auugstin. The applicant is requesting a license for a capacity of 14. The Fairfield Fire Department conducted a Fire Safety Inspection on 02/01/19 and the facility was granted a fire clearance to operate at a capacity of 14. Services will be provided Monday - Friday; 6:30am. - 5:30pm. The applicant understands that child care must be provided in the "primary" residence of the applicant. The residence is a three bedroom/two bath home. There are two adults and one minor living in the home. Applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. All minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday and obtain a TB clearance. The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance. The floor and yard plans are verified. The three bedrooms, one bathroom and the garage are off limits to the children. These areas have been made inaccessible by means of a child safety gate and a door latch mechanism. The home appears to be clean and orderly at this time and will remain so during child care hours. There is a working telephone. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. The poisons are locked in a container stored in the yard. The applicant reports there are no weapons in the home and none were observed during the visit. The children in care will have access to age appropriate toys and equipment. The home is equipped with a working smoke detector, carbon monoxide detector; and fire extinguisher rated at least 2A10BC. The fireplace is securely screened with a shelf. The children will use the backyard as the outdoor play area. The backyard is completely fenced. There is no trampoline on the premises. The applicant has a small dog in the home. There is no pool, spa, pond, fountain, nor any other source of water accessible to the children, and none is to be added without prior notification and approval of the licensing agency. Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. The applicant stated she plans to purchase liability insurance.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2019

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: BRAZEEL, ANGELA FCCH	FACILITY NUMBER: 483009725
	VISIT DATE: 06/28/2019

NARRATIVE

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Proof of control of property or landlord notification/consent is on file. The applicant's AB 1207 Mandated Reporter Training certificate and proof of immunity against the Measles, Pertussis and Influenza are on file. Parent's rights are posted. Emergency drills must be conducted at least once every six months and the date documented. Children's records to be maintained were reviewed. The roster is to remain current at all times. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days. The applicant will maintain current on Pediatric CPR and First Aid. The applicant shall be present in the home and shall ensure that children in care are supervised by a fingerprinted adult with current Pediatric CPR and First Aid certification. The applicant understands that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. The applicant clearly understands the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school aged. Smoking is prohibited during the hours of operation in those areas where children are present.

This facility plans to provide Incidental Medical Services - IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan for providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) 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, available at: http://www.ada.gov/childqanda.htm. LPA requested a Plan for Providing IMS from the applicant. This report, as well as the AAP Guide to Safe Sleep Practices brochure and the Effective of Lead Exposures, were reviewed and discussed with the applicant.

The applicant understands the responsibility to read and have knowledge of the laws and regulations for operation of a family child care home. Forms and regulations must be obtained from the website. http://ccld.ca.gov/. Megan's Law web site was provided (http://www.meganslaw.ca.gov). The applicant understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

The facility is ready for licensure effective 06/29/19.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2019

LIC809 (FAS) - (06/04)

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