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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423870
Report Date: 06/16/2023
Date Signed: 06/16/2023 02:37:46 PM

Document Has Been Signed on 06/16/2023 02:37 PM - 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:JOHNSON, LATRICE & SHEFFIELD-JOHNSON, GABRIELLEFACILITY NUMBER:
013423870
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/16/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Latrice Johnson & Gabrielle Sheffield-JohnsonTIME COMPLETED:
03:30 PM
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On 06/16/2023 at 1:30 PM Licensing Program Analyst (LPA), A. Curry arrived at the home and conducted an announced Prelicensing inspection. LPA met with applicants, Latrice Johnson & Gabrielle Sheffield-Johnson, who submitted an application for a small Family Child Care Home. The hours of operation for the family child care home will be Monday-Friday 6:00am-6:00pm. A tour of the home was completed with the applicants to conduct a health and safety inspection.

The home is three-stories and consist of 4 bedrooms, 3 bathrooms, living room, kitchen, patio, and garage, which is converted into a day care classroom. The children will use the entire first floor, which consist of bedroom/napping room, bathroom, and garage/classroom. The applicants were advised that day care children should not be napping or eating in the garage. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for safety and comfort. The off-limits areas are the entire upstairs of the home. The second floor consist of 1 bedroom, 1 bathroom, kitchen, living room, and patio. The third floor consist of 2 bedrooms and 2 bathrooms. The off-limit areas will be inaccessible by closed and/or locked doors and visual supervision. The Isolation area will be the napping room. The applicants stated they will use the local park for outdoor play. LPA reminded the applicants to have 100% visual supervision of children when outside of the home. The applicants were advised that any area that will be changed to an on limit area will need to be inspected by Licensing prior to use. There were safe toys, play equipment, and materials observed for children. LPA did not observe any bodies of water, toxins, medications or hazardous items that would be accessible to children. The applicants were advised that all poisons and/or hazardous items must be kept in a locked cabinet/drawer or placed out of reach of children. There is a safety gate at the bottom of the stairs. The applicants stated there are no firearms on the premises.



The home is equipped with a fully charged 3A40BC fire extinguisher, working dual smoke alarm and carbon monoxide detector, telephone, and first aid supplies. The applicants completed the required preventative health and safety training, which includes 1 hour of nutrition, the required lead poisoning prevention training, and has current CPR and First Aid training which expires on November 09, 2024 and January 17, 2025 respectively.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2023
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: JOHNSON, LATRICE & SHEFFIELD-JOHNSON, GABRIELLE
FACILITY NUMBER: 013423870
VISIT DATE: 06/16/2023
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LPA reviewed with applicants the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LPA advised the applicant that the postings need to be in a place that is visible and accessible to the public. LPA reviewed the ratio and capacity of a small family child care home license.

LPA discussed the safe sleep regulations with the applicants 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 the applicants 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. LPA reviewed safe sleep regulations and provided a brochure and safe sleep plan (LIC 9227) for the applicant’s records.

The applicant is reminded of the following: to review and follow COVID-19 guidelines and to report any injuries or unusual incidents. The applicant is advised to review licensing regulations and guidelines, including the Provider Information Notices (PINs) on the website www.ccld.ca.gov and to sign up to receive quarterly updates by email by sending a request to ChildCareAdvocatesProgram@dss.ca.gov.



Incidental Medical Services (IMS) policy was discussed. 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.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
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: JOHNSON, LATRICE & SHEFFIELD-JOHNSON, GABRIELLE
FACILITY NUMBER: 013423870
VISIT DATE: 06/16/2023
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The applicant were reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 verified the applicants have a criminal record clearance and is associated to the license. The applicants were reminded of the responsibility as a mandated reporter. The licensee was reminded that the mandated reporter training needs to be renewed every 2 years, at www.mandatedreporterca.com.


This home will be licensed effective today, 06/16/2023. An exit interview was conducted, appeal rights were given, and the reports was reviewed with the applicants.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
LIC809 (FAS) - (06/04)
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