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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010152
Report Date: 01/26/2022
Date Signed: 01/26/2022 09:19:40 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:BAISDEN-NICKELBERRY, SHEREE' FCCHFACILITY NUMBER:
483010152
ADMINISTRATOR:B-NICKELBERRY SHERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 342-9797
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY:14CENSUS: 1DATE:
01/26/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Sheree Baisden-NickelberryTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an announced Pre-Licensing visit to follow up on several items which needed to be corrected. LPA previously conducted a Pre-Licensing Inspection on 01/21/22 and at that time, the wooden balcony stairs in the backyard was not barricaded, one adult had not obtained a criminal record clearance, and at least one pack and play for one infant enrolled was required.

During today's visit, LPA observed one pack and play that was enclosed with fabric mesh, the wooden balcony stairs in the backyard were barricaded with a wooden safety gate that contained a latch. Department records reviewed on 01/26/22 indicated that all adults working or residing in the home obtained an approved criminal record clearance or exemption. 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.

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.

This report was discussed and reviewed with the applicant. The facility is granted a Large Family Child Care Home license to operate with a capacity of 14, effective, 01/26/2022.

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
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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