485407982-9-20-2021-13-CC-KMAS-C72PP3-20210920112852

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 485407982
Report Date: 09/20/2021
Date Signed: 09/20/2021 11:28:59 AM

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:	BROWN, EBONY FAMILY CHILD CARE HOME		FACILITY NUMBER:	485407982
ADMINISTRATOR:	BROWN, EBONY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 478-8751
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95687
CAPACITY:	14	CENSUS:	DATE:	09/20/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Applicant, Ebony Brown		TIME COMPLETED:	11:45 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 pre-licensing inspection was conducted by Licensing Program Analysts (LPA) Kirk Marks. The applicant is requesting licensing for a large family child care home with capacity not to exceed 14. Operational hours are 7:30am to 4:30pm, Monday - Friday.. The residence is a two story, five bedroom/three bath home. There are three 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 Community Care Licensing Department. 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 civil penalty for adults working or residing in the home without a criminal record clearance. Fire clearance was granted on 9/15/2021. The accessible areas of the home are one downstairs bedroom and bathroom. The areas in the home that are off-limits are the kitchen, living room and garage downstairs and the entire upstairs which includes four bedrooms, two bathrooms and laundry room. These areas will be made inaccessible with locking gates. A nearby park will be the primary outdoor play area. The back yard is fully fenced, but has not been set up for a children's play area at the time of the inspection. The licensee understands that full supervision is required when utilizing the park as the outdoor play area. The home was clean and orderly at this time and will remain so during child care hours. There is a working telephone in the home. The sharp knives are stored out of reach of children in the kitchen. Cleaning supplies are stored in a closet and inaccessible to children. Medications are stored inaccessible in a top shelf in the pantry. The home has a fireplace that has been gated and will be secured. The applicant stated there are no firearms/weapons on the premises and none were observed during the inspection. The children in care will have access to age appropriate toys and equipment. The home is equipped with at least one working smoke detector, carbon monoxide detector and a charged fire extinguisher rated at least 2A10BC.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Kirk Marks	TELEPHONE: (530) 895-5045
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

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

FACILITY NAME: BROWN, EBONY FAMILY CHILD CARE HOME	FACILITY NUMBER: 485407982
	VISIT DATE: 09/20/2021

NARRATIVE

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Licensee is not currently carrying liability insurance for the children, but may choose to carry insurance at a later date. Parents' rights are posted. Emergency drills must be conducted at least once every six months and the date must be documented. The applicant shall be present in the home and shall ensure that children in care are supervised by a finger-printed adult with current Pediatric CPR and First Aid certification. Applicant has completed pediatric CPR/ First aid certification which expires on 3/2022. The applicant completed Mandated Reporter Training on 8/24/2021. The applicant understood 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 understood 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; when caring for over 12 children, one of the children in care and must be school-aged and one must be at least 6 years of age. Smoking is prohibited in the home at all times and in outdoor areas where children are present. Incidental Medical Services (IMS) will not be provided and 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. Safe sleep regulations were discussed with the applicant. The applicant understood the responsibility to read and have knowledge of the laws and regulations for the 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 at http://www.meganslaw.ca.gov. The licensee understood that any authorized employee of the Department may enter and inspect the facility with or without advance notice. This report was reviewed and discussed with the applicant. 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
Applicant will send photos of complete set up of the home prior to becoming licensed.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Kirk Marks	TELEPHONE: (530) 895-5045
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

LIC809 (FAS) - (06/04)

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