073409743-2-28-2025-02-CC-CWAS-DEBTMH-20250228135109

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409743
Report Date: 02/28/2025
Date Signed: 02/28/2025 01:51:56 PM

Document Has Been Signed on 02/28/2025 01:51 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:	WORDOFA, NETSANET		FACILITY NUMBER:	073409743
ADMINISTRATOR/ DIRECTOR:	NETSANET WORDOFA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 228-7187
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	02/28/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Netsanet Wordofa		TIME VISIT/ INSPECTION COMPLETED:	01:50 PM

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	On 02/28/2025 at 09:30 AM, Licensing Program Analysts (LPA) Christina Watts conducted an announced Pre-licensing Inspection and met with Applicant, Netsanet Wordofa who has applied for a Large Family Child Care Home with a capacity of fourteen (14). Living in the home are applicant and applicant's spouse. Days and hours of operation will be Monday – Friday from 7:00 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 10/2025, has documentation for Measles, Pertussis, and Influenza vaccine. Applicant and adults living in the home have 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 12/2025. The applicant provided proof of control of property. LPA reminded that when care for more than twelve and up to fourteen is provided, Applicant must notify parents. 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. Fire Safety Clearance was given to this facility on 02/11/2025 by Inspector Chris Giddis of the Contra Costa County Fire Protection Department. Per the Fire Safety Inspection Request, the garage is placed off limits to children. This is a one story Home comprises of 3 bedrooms, 2 bathrooms, Living Room, Family Room (Daycare Room), Kitchen, Dining room, attached garage and backyard. Areas on limits: Family Room (Daycare Room), Dining Room, Kitchen, Hallway Bathroom, and front area of backyard. Applicant will be utilizing the family room (daycare room) as the main room for her day care area. Off-Limit Areas: 3 bedrooms including master bedroom, master bathrooms Living Room, attached garage, and upper portion of backyard. Isolation Area: Family Room (Daycare Room) *CON'T ON PAGE 2*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

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: WORDOFA, NETSANET	FACILITY NUMBER: 073409743
	VISIT DATE: 02/28/2025

NARRATIVE

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*PAGE 2*

LPA toured the indoor space of the home. The home is sanitary and orderly, with heating and ventilation for safety and comfort. There are no stairs in the home. Fireplace is located in the Family Room (Daycare Room) and made inaccessible to children in care. LPA observed fully charged 2A10BC fire extinguisher, working smoke, carbon monoxide detector. Applicant placed living room off limits. The living room will be used as an entrance and exit to Family Room (Daycare Room) and to the hallway bathroom. Applicant cannot use the living room or hallway as an area to supervise and care for children. 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 is a firearm and ammunition stored in the home. LPA observe firearm and ammunition. Both items are in an off limit area in separate lock boxes.

Outdoor Space: LPA toured the outdoor area. LPA observed a fenced and safe backyard for children in care. LPA also observed age appropriate toys for children to play with. No bodies of water were observed. Children will be using the backyard and nearby park for outdoor activity. LPA reminded applicant when outside of facility, 100% supervision of children in care is required.

Applicant understands that children's personal rights should not be violated and no 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.

LPA discussed and reminded the applicant day care needs to be operated within the limitations and capacity of a Large 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. *CON'T ON PAGE 3*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

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: WORDOFA, NETSANET	FACILITY NUMBER: 073409743
	VISIT DATE: 02/28/2025

NARRATIVE

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*PAGE 3*

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 webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

On this date, 12/18/2024, 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.

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. *CON'T ON PAGE 4*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

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: WORDOFA, NETSANET	FACILITY NUMBER: 073409743
	VISIT DATE: 02/28/2025

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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 02/28/2025, applicant's application for a large family child care home is approved.

Exit interview was conducted with Applicant, Netsanet Wordofa and signed the report acknowledging receipts of documents.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

LIC809 (FAS) - (06/04)

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