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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423660
Report Date: 11/15/2021
Date Signed: 11/15/2021 11:25:13 AM

Document Has Been Signed on 11/15/2021 11:25 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:MILLER, YALINFACILITY NUMBER:
013423660
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
11/15/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Yalin Miller TIME COMPLETED:
11:30 AM
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On 11/15/21 at 9:00 AM Licensing Program Analyst (LPA) Michelle Sutton conducted an announced Pre-licensing Inspection at Yalin Miller's home and met with Applicant, Yalin Miller, who has applied for a Small Family Child Care Home with a capacity of 8 children. The home was toured to conduct a Health and Safety Inspection. Present during today’s inspection is Yalin, applicant's mother and applicant's daughter who is 23 months. The Child Care home plans to operate Monday-Friday from 7am-6pm. Living in the home is applicant, applicant's spouse and daughter.

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.

INDOOR SPACE: At 9:10 AM LPA toured the indoor space of the home. The home consists of living room (indoor playroom), dinning room, kitchen, garage, backyard, 2 bedrooms and 1 bathroom. The home is in compliance with Title 22 Regulations at this time.
LPA observed: fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detector in indoor play room. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets with latches. LPA reminded Applicant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Applicant states that there is 1 dog and no arms and ammunition stored in the home.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2021
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MILLER, YALIN
FACILITY NUMBER: 013423660
VISIT DATE: 11/15/2021
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IN-USE AREAS: Living room, dining room, kitchen, laundry room, bathroom and backyard (play yard)
OFF-LIMIT AREAS: Bedroom 1, Bedroom 2, side yard, and garage. Applicant has child proof doorknobs on all off-limit doors.
OUTDOOR SPACE: AT 9:35 AM LPA toured the outdoor area (backyard). For children to access the backyard, children walk through the kitchen and laundry room. LPA observed the backyard was fenced and garage is next to play yard that is inaccessible to children with locked fence. There are no water body in play yard, LPA discussed with applicant that there needs to be 100% supervision when children are playing with water.

Applicant completed the 16-hour Preventative Health training which includes EMSA approved CPR and first aid, one hour of Child Care Nutrition and Lead Poisoning. Applicant has documentation maintained for Measles, Pertussis Immunizations, Influenza vaccination for the current flu season and Tuberculosis (TB) clearance. Applicant has Criminal Record statement and Child abuse Index Clearance. Applicant has submitted proof of ownership of home to CCLD.

LPA reminded Applicant that when care for more than six and up to eight is provided, Applicant must notify parents and obtain landlord consent. Applicant will use the Affidavit Regarding Liability Insurance form to inform parents that she does not carry day care insurance as of now. Applicant has a working telephone in the home.

Discipline policy was discussed, and Applicant stated she will talk to the children and use "quiet time" as form of discipline. Applicant understands that children's personal rights should not be violated and no corporal punishment. Isolation of sick children is in the kitchen, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries and requirements for assistant/substitute were also discussed. Fire drills must be practiced once every six months and documented.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MILLER, YALIN
FACILITY NUMBER: 013423660
VISIT DATE: 11/15/2021
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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 Yalin Miller 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 licensee 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.

The Family Child Care Home packet with copies of all required forms and documents needed for starting the day care were provided to applicant. LPA also reviewed all the forms with the Applicant. AT 11:15 AM Exit interview was conducted with Yalin Miller and she signed the report acknowledging receipts of documents.
END OF REPORT
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
LIC809 (FAS) - (06/04)
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