<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700354
Report Date: 06/08/2022
Date Signed: 06/08/2022 11:15:56 AM

Document Has Been Signed on 06/08/2022 11:15 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:KIKON, JULIEFACILITY NUMBER:
015700354
ADMINISTRATOR:KIKON, JULIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 908-3345
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
06/08/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee, Julie Kikon TIME COMPLETED:
11:35 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
Licensing Program Analyst (LPA) Saini met Applicant Julie Kikon for a prelicensing visit today at this home. The purpose of this inspection was explained. This is a change of location from a previously licensed family childcare home. The facility was previously licensed at 1044 AVON AVE. SAN LEANDRO CA 94579. Applicant stated that she lives in this house with her daughter and her mother. Applicant is applying for a Large family childcare license with hours of operation: Monday through Friday 7:30am to 5:30pm. Capacity requirements were discussed today. Criminal record clearances are on file and will be transferred to this location. The entire house was inspected for health and safety hazards. Present during the visit was applicant and her mother, supervising 1 infant and 1 preschooler.
The home is a single-story home with 4 bedrooms, 2.5 bathroom, a living room, a kitchen, dining area, laundry room, deck and back yard, which is completely fenced in, this portion of the home is considered the "main" home. The garage was converted into an in-law suite. The in-law suite consists of a living room, 1 bedroom, 1 bathroom and a kitchen. The in-law suite and the entire backyard will be the only daycare area for children. Per Licensee, day care children will be entering/exiting through the backyard door to get into the day care area.
Applicant understands that all off limits areas of the home shall be kept inaccessible to children via barricade, locked doors, and/or visual supervision. The home has smoke detectors, a working cell phone, and first aid/emergency kit supplies. Per applicant, there are no firearms or weapons in the home. All sharp objects, cleaning supplies and other toxic items are stored out of reach of the children. There are no pools, ponds, hot tubs, or any other bodies of water on the facility premises currently. Applicant has required Preventive Health and Safety Training certificate, including lead poisoning prevention update. The Facility will be providing snacks and children will be bringing own lunch. Provider stated that, she might starts providing lunch eventually. Applicant's First Aid/CPR certificate expires in 07/2023. Mandated Reporter training certificates for Applicant are current and expire on 06/24/2023. Applicant is reminded of NO walker, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible. Smoking is prohibited in family childcare homes. The Applicant is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.
see next page...
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: KIKON, JULIE
FACILITY NUMBER: 015700354
VISIT DATE: 06/08/2022
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
26
27
28
29
30
31
32
Applicant was 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 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. Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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


Large Family Child Care License is recommended effective 06/08/2022


Exit interview conducted and report was reviewed with the Applicant, Julie Kikon,
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2