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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409492
Report Date: 11/29/2023
Date Signed: 11/29/2023 04:47:00 PM

Document Has Been Signed on 11/29/2023 04:47 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:SCOTT-JEFFERSON, MAKAYLAFACILITY NUMBER:
073409492
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/29/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Makayla Scott-JeffersonTIME COMPLETED:
05:00 PM
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On 11/29/2023 at 2:00 PM, Licensing Program Analyst (LPA) Christina Watts conducted an announced Prelicensing Inspection and met with Applicant, Makayla Scott-Jefferson, who has applied for a Small Family Child Care Home with a capacity of eight (8). Living in the home are applicant and applicant's minor aged infant child. Only applicant was present during inspection. Days and hours of operation will be Monday – Friday from 6:00 AM - 6:00 PM.

Applicant completed 8 hour Preventative Health & Safety training, Nutrition and Lead Poisoning training, 8 hour Pediatric CPR & First Aid Certificate that expires 09/2025, has documentation for Measles, Pertussis, and Influenza opt out statement for the current flu season. Applicant has Criminal Record and Child Abuse Index Clearance and documentation for Tuberculosis (TB) clearance. Applicant has completed and submitted certificate for Mandated Reporter training which expires 11/2025. The applicant provided proof of control of property. Because the applicant rents/leases the home, proof of landlord notification is required. LPA observed the Property Owner/Landlord Notification form (LIC 9151) that the applicant confirms was provided to the property owner/landlord. The applicant has not obtained a signed Property Owner/Landlord Consent form (LIC 9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 6 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 children. LPA reminded applicant that when care for more than six and up to eight is provided, applicant must notify parents and provide parents form LIC 9150 - Parent Notification of Additional Children in Care. Applicant will use the Affidavit Regarding Liability Insurance form to inform parents they do not carry a day care insurance. Applicant has a working telephone in the home.


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SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2023
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 4
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: SCOTT-JEFFERSON, MAKAYLA
FACILITY NUMBER: 073409492
VISIT DATE: 11/29/2023
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*PAGE 2*

This is a two story apartment that comprises of 3 bedrooms, 2 bathrooms, Living Room, Kitchen, Dining room, and backyard.
Areas on limits: Living Room, first floor bedroom, first floor bathroom, office (2nd bedroom), central and right side of backyard. Applicant will be utilizing the living room as the main room for her day care area.
Off-Limit Areas: Master bedroom, master bathroom, kitchen, dining room, and left side of backyard
Isolation Area: Office (first floor 2nd bedroom)

LPA toured the indoor space of the home. The home is sanitary and orderly, with heating and ventilation for safety and comfort. LPA observed a wall furnace which is attached to the wall and made inaccessible to children in care. There are stairs in the home that are made inaccessible to children. LPA observed a fully charged 2A10BC fire extinguisher, working smoke, and carbon monoxide detector. Medicines, cleaning products, sharp objects are stored inaccessible to children. Door access to off limit areas are made inaccessible to children. LPA reminded applicant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care home. Applicant states there are no firearms and ammunition stored in the home. Applicant stated there are no pets in the home.

Outdoor Space: LPA toured the outdoor area. LPA observed a fully fenced and safe backyard for children in care. LPA also observed age appropriate toys for children to play with. On the right side of facility, there is a wooden gate that will kept locked at all times. LPA did not observe any bodies of water in the backyard. Children will be using the backyard and a park near the facility for outdoor activity. LPA discussed with applicant that there needs to be 100% supervision when outside of the facility. Applicant not provide transportation for children and understands that children cannot be left alone, unattended in parked vehicles.


Applicant understands that children's personal rights should not be violated and nor corporal punishment. Isolation of sick children, 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 conducted once every six months and documented. A Family Child Care Home packet was provided to and reviewed with the Applicant

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SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: SCOTT-JEFFERSON, MAKAYLA
FACILITY NUMBER: 073409492
VISIT DATE: 11/29/2023
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*PAGE 3*

LPA discussed and reminded applicant day care needs to be operated within the limitations and capacity of a Small Family Child Care Home with regards to ratios and that Licensee has to be present in the day care for 80% of the operation hours.

LPA reviewed with applicant 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (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, and discussed the Child Care Licensing Safe Sleep web page 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.

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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: SCOTT-JEFFERSON, MAKAYLA
FACILITY NUMBER: 073409492
VISIT DATE: 11/29/2023
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*PAGE 4*

On this date, 11/07/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Website links for provider resources:


Licensing forms, Title 22 regulations, can be obtained through the internet at www.cdss.ca.gov
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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

As of 11/29/2023, applicant's application for a small family child care home has been approved.

Exit interview was conducted with Applicant, Makayla Scott-Jefferson and signed the report acknowledging receipts of documents.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4