483009934-5-29-2020-01-CC-MAUN-BQ3QY6-20200529123438

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483009934
Report Date: 05/29/2020
Date Signed: 05/29/2020 12:34:46 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:	PERKINS, DIONNA FCCH		FACILITY NUMBER:	483009934
ADMINISTRATOR:	PERKINS, DIONNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 342-4150
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94590
CAPACITY:	14	CENSUS: 0	DATE:	05/29/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Dionna Perkins		TIME COMPLETED:	09:30 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 Zoom Pre-Licensing Tele-Inspection was conducted by Licensing Program Analyst (LPA), Melchisedeck Augustin for the purpose of changing the facility's location. The Department has suspended all field operations due to COVID-19, and the applicant has agreed to attend the Zoom Tele-Inspection with LPA. On 05/21/20, the Vallejo Fire Department granted the home a fire clearance to operate with a capacity of 14. Services will be provided Mon- Fri; 8:00am - 5:00pm. The applicant understands that childcare must be provided in the "primary" residence of the applicant. The residence is a two bedroom/two bath home. There are two adults and two 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. There are two bedrooms and one bathroom on the upper level, living room, dining area, kitchen basement and the garage are off limits to the children. These areas have been made inaccessible by means of door locking mechanisms, however, the garage must be made inaccessible. The home has a staircase on the first floor that leads to the day care room and second story. The staircase that leads to the day care room is barricaded at the top and bottom with children's safety gates; and the stairs that leads to the second floor were barricaded with a physical locking door. The home appears to be clean and orderly at this time and will remain so during childcare hours. There is a working telephone. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. The applicant reported there were no poisons in the home. 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. The children will use the backyard as the outdoor play area and the backyard is completely fenced. There is no trampoline on the premises. There is an in-ground pool in the backyard yard, and the pool does not meet Title 22 regulations fencing requirements. The applicant acknowledges and understands that the pool is mandated to comply with fencing requirements.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2020

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: PERKINS, DIONNA FCCH	FACILITY NUMBER: 483009934
	VISIT DATE: 05/29/2020

NARRATIVE

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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. 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 certifications. 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; and PIN 20-06-CCP, 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. 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 applicant’s signature was not recorded on this Facility Evaluation Report (LIC 809), however, the applicant was provided with a copy of this report; and the applicant’s proof of Read Receipt is on file. The following needs to be completed prior to the granting of license. Please include facility number in all correspondence.
1. Provide evidence that pool complies with Title 22 fencing requirements.
2. Provide evidence that the garage is inaccessible.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2020

LIC809 (FAS) - (06/04)

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