483009907-4-17-2020-01-CC-MAUN-BNRRAU-20200417125143

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483009907
Report Date: 04/17/2020
Date Signed: 04/17/2020 12:51:56 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:	WADDELL, ANTOINISHA FCCH		FACILITY NUMBER:	483009907
ADMINISTRATOR:	WADDELL, ANTOINISHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 731-7762
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94589
CAPACITY:	14	CENSUS: 0	DATE:	04/17/2020
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Antoinisha Waddell		TIME COMPLETED:	11:00 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	Due to COVID-19, on 3/24/2020 at 9:34am Licensing Program Analyst (LPA) Melchisedeck Augustin completed a pre-licensing tele-visit by reviewing the pre-licensing checklist and requiring the applicant to submit pictures of all inspection areas. The Department suspended all field operations due to COVID-19 and the Pre-Licensing tele-visit was conducted for the purpose of relocating the facility. The applicant requested a license for a capacity of 14, and on 03/16/20, the Vallejo Fire Department granted the facility a fire clearance to operate with a capacity of 14. Services will be provided Mon – Fri, 6:30am to 7:30pm. The applicant understands that childcare must be provided in the "primary" residence of the applicant. The residence is a 4 bed/2 bath home. There is one adult and three minors 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 are off limits to the children. These areas have been made inaccessible by means of doorknob cover and children’s safety gates. The on limits area of the home are the one bedroom, one bathroom, family room, kitchen, and the backyard. The children will utilize the garage for additional play space. The home appeared to be clean and orderly at this time and will remain so during childcare hours. All electrical outlets appeared to be covered with plastic covers. There was a working telephone. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. The stove knobs were inaccessible. The applicant reported there were no poisons at the facility. The applicant reported 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. The children will use the backyard as the outdoor play area. The backyard appeared to be completely fenced. The applicant reported there is no trampoline on the premises.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2020

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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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: WADDELL, ANTOINISHA FCCH	FACILITY NUMBER: 483009907
	VISIT DATE: 04/17/2020

NARRATIVE

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The applicant reported 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 childcare liability insurance. Proof of control of property or landlord notification/consent is on file. The applicant’s proof of immunity against the Measles, Pertussis and Influenza, and AB 1207 Mandated Reporter Training certificate are on file. Parent's rights are posted on the parent board. Emergency drills must be conducted at least once every six months and the date documented. Children's records are always to be maintained. The roster is to remain current at all times. Unusual Incident Report procedures 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 (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. 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 applicant. This report, as well as the AAP Guide to Safe Sleep Practices the Effects of Lead Exposure brochures, 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 childcare home. Applicant's original signature is not recorded on this report, however, the applicant was provided with a copy of the Facility Evaluation Report, and applicant's signature is on file.

The facility is ready for Provisional license effective 03/25/20. The following needs to be completed prior to the granting of regular license.
1) Submit applicant's evidence of negative TB clearance (must be within 12 months)

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2020

LIC809 (FAS) - (06/04)

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