485407767-8-14-2020-13-CC-EGRK-BSGTXJ-20200814150712

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 485407767
Report Date: 08/14/2020
Date Signed: 08/14/2020 03:08:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	JONES, SKYLAR FAMILY CHILD CARE HOME		FACILITY NUMBER:	485407767
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	08/14/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Skylar Jones		TIME COMPLETED:	03:10 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 was conducted today by LPA, Emilia Grisak. The facility inspection was conducted via tele-inspection due to the current state of emergency regarding the COVID-19 outbreak. The applicant is requesting a license for a capacity of 8. Services will be provided Monday - Friday; 7:30am - 5:30pm. The applicant understands that child care must be provided in the "primary" residence of the applicant. The residence is a three bedroom/two bath home. There are two adults 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 garage, master bedroom, closets and backyard are off limits to the children. These areas have been made inaccessible by means of door knob covers. The home appears to be clean and orderly at this time and will remain so during child care hours. There is a working telephone. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. There are no poisons stored in the home at this time and applicant understands poisons must be locked. 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 and fire extinguisher rated at least 2A10BC. The fireplace is securely screened. The backyard is off limits at this time and the applicant understands that constant supervision must be provided while children are outside if the yard is not fully fenced. There is no trampoline on the premises. 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 child care liability insurance. Proof of control of property is on file. Parent's rights are posted in the daycare room. Emergency drills must be conducted at least once every six months and the date documented.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Emilia Grisak	TELEPHONE: (530) 895-5821
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2020

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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: JONES, SKYLAR FAMILY CHILD CARE HOME	FACILITY NUMBER: 485407767
	VISIT DATE: 08/14/2020

NARRATIVE

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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.

The applicant understands the responsibility to read and have knowledge of the laws and regulations for operation of a family child care 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 licensee understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice. This report, as well as the American Association of Pediatrics Guide to Safe Sleep Practices brochure, were reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

The facility will be processed for licensure.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Emilia Grisak	TELEPHONE: (530) 895-5821
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2020

LIC809 (FAS) - (06/04)

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