197495008-5-6-2022-30-CC-SORS-CE6Q6B-20220506115318

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197495008
Report Date: 05/06/2022
Date Signed: 05/06/2022 11:53:29 AM

Document Has Been Signed on 05/06/2022 11:53 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	JACOBS FAMILY CHILD CARE		FACILITY NUMBER:	197495008
ADMINISTRATOR:	RENEE JACOBS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 414-9988
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	05/06/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Renee Jacobs- Licensee		TIME COMPLETED:	12:00 PM

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On 5/6/2022, Licensing Program Analyst (LPA) Suzette Ornelas and Licensing Program Manager (LPM) Lisa Rios conducted an announced inspection and met with applicant to observe corrections from a prior pre-licensing inspection that took place on 3/18/2022.

LPAs observed the following corrections:

Windows blind cords located in all on-limit areas were observed inaccessible to children in care by cord holders. Candles in 1^st living room were removed and made inaccessible to children in care. Heater in hall/living room area is inaccessible to children in care by magnetic covers. Laundry room is on-limits and 2 drawers were observed to be inaccessible to children in care by installing child proof latches. Air conditioning unit in the backyard was observed inaccessible to children in care by a cover and a child safety gate. Small metal table/chairs in the backyard were removed and are no longer accessible to children in care. Bricks/small space behind storage shed in the backyard was made inaccessible to children in care by a child proof gate. Narrow right side of the home is inaccessible to children by the installment of a baby gate. Broken jacuzzi parts were repaired and no longer have sharps that pose a threat to children in care. Broken hose case was replaced. Hazardous materials are inaccessible and kept out of the reach of children, including dog feces. Applicant is aware that after one year she can apply for a Large family child care home.

All corrections have been completed. Exit interview was conducted with applicant Renee Jacobs. The home is in substantial compliance and ready for licensure. The licensing determination of this application will be reviewed with Licensing Program Manager for final resolution.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: JACOBS FAMILY CHILD CARE	FACILITY NUMBER: 197495008
	VISIT DATE: 05/06/2022

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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.

Exit interview conducted and report was reviewed with the applicant, Renee Jacobs.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

LIC809 (FAS) - (06/04)

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