483010152-1-21-2022-01-CC-MAUN-CAVRBG-20220121115244

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483010152
Report Date: 01/21/2022
Date Signed: 01/21/2022 11:52:55 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME:	BAISDEN-NICKELBERRY, SHEREE' FCCH		FACILITY NUMBER:	483010152
ADMINISTRATOR:	B-NICKELBERRY SHER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 342-9797
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94589
CAPACITY:	14	CENSUS: 2	DATE:	01/21/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Sheree Baisden-Nickelberry		TIME COMPLETED:	12:15 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 Pre-licensing inspection visit was conducted today by Licensing Program Analyst (LPA), Melchisedeck Augustin to change the facility’s location and increase the facility’s capacity. The applicant is requesting a license for a capacity of 14. On 01/06/22, the Vallejo Fire Department granted the facility a fire clearance to operate at a capacity of 14. Services will be provided Sunday - Saturday; 4:00am – 5:00am. The applicant understands that childcare must be provided in the "primary" residence of the applicant. The residence is a three bedroom/two bath home. There are four 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 was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. The floor and yard plans are verified. The entire upstairs which includes two bedrooms and one bathroom, the kitchen, outdoor shed, garage are off limits to the children. These areas have been made inaccessible by means of children’s safety gates, door locking mechanisms and plastic doorknob covers. 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 hot water in the bathroom took longer than 43 seconds to get warm. The applicant reported there were no poison in the home, and none were observed. The staircase in the living room was barricaded with a child safety gate. The staircase in the kitchen that leads to the lower level garage was barricaded with a physical door that contained a doorknob cover. The wall heaters in the living room and hallway near the double French doors were securely screened. 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. (Continue to LIC 809-C)

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2022

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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: BAISDEN-NICKELBERRY, SHEREE' FCCH	FACILITY NUMBER: 483010152
	VISIT DATE: 01/21/2022

NARRATIVE

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The home is equipped with a working smoke and carbon monoxide detectors; and fire extinguisher rated at least 2A10BC. The children will use the backyard as the outdoor play area and the backyard was completely fenced, however; the wooden balcony stairs were not barricaded. 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. The applicant’s current AB 1207 Mandated Reporter Training certificate, evidence of negative TB clearance, and required immunization record are on file. 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. 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. LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. (Continue to LIC 809-C)

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2022

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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: BAISDEN-NICKELBERRY, SHEREE' FCCH	FACILITY NUMBER: 483010152
	VISIT DATE: 01/21/2022

NARRATIVE

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LPA reviewed COVID-19 Child Care Program guide and Pre-Licensing Packet 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 approval of facility license is pending. Please correct the following items:
1. The wooden balcony stairs in the backyard is required to be barricaded.
2. One adult is required to obtain an approved criminal record clearance or exemption.
3. Evidence of at least one pack and play for one infant enrolled.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2022

LIC809 (FAS) - (06/04)

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