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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009951
Report Date: 09/10/2021
Date Signed: 09/10/2021 11:52:52 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:POWELL, DENISHIA FCCHFACILITY NUMBER:
483009951
ADMINISTRATOR:POWELL, DENISHIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 563-0903
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:14CENSUS: 4DATE:
09/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Denisha Powell, LicenseeTIME COMPLETED:
12:05 PM
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A Required- 1 year inspection was made to the facility by Licensing Program Analyst (LPA) Kevin O'Connell. A review of staff records on 09/10/21 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there is one adult living in the home.
During today’s inspection the home and grounds were toured.
The licensee was supervising four 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 Mon - Fri; 12:00am - 11:30pm
Children will have access to entire downstairs. There is a gate at the bottom of the stairs to prevent access to the second floor. There are also latches on the laundry door knobs to prevent access.
The home was clean and orderly, and was at a comfortable indoor temperature. There were safe toys and equipment available for children. There is a working telephone in the home. The Licensee has current pediatric CPR and First Aid certifications which expires 6/23.
Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) were stored out of the reach of children. Poisons are key locked in a outside cabinet. There is no fireplace. There is a working smoke detector, carbon monoxide detector and a 3A 40BC charged fire extinguisher. The Licensee states that there are no firearms or dangerous weapons and none were observed. The Licensee states that there are no pools, spas, or water features and none were observed.
The back yard is fully fenced and is used for outdoor play.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
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,
, CA
FACILITY NAME: POWELL, DENISHIA FCCH
FACILITY NUMBER: 483009951
VISIT DATE: 09/10/2021
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One staff file was reviewed at 11:15am for Mandated Reporter Certificates and immunizations and all were current. Children's records were reviewed at 11:20am; required emergency information cards were observed to be on file. There are no children receiving Incidental Medical Services at this time.
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 was 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.

No Title 22 violations were cited during today's inspection.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
LIC809 (FAS) - (06/04)
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