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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313622189
Report Date: 07/19/2021
Date Signed: 07/19/2021 02:09:11 PM

Document Has Been Signed on 07/19/2021 02:09 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:BILGI, AYSE & BILGI, AVNIFACILITY NUMBER:
313622189
ADMINISTRATOR:BILGI, AYSE & BILGI, AVNIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(401) 612-4677
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
07/19/2021
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ayse & Avni Bilgi - LicenseesTIME COMPLETED:
02:30 PM
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An unannounced annual/random inspection is made today by LPA Katrina Owens. Present at time of inspection were licensees and 6 day care children. Ages of children present were 1 1/2, 1 1/2, 3,2,7 and 2 years old. Licensee is not a Foster Parent, nor have any other licenses.

A tour of the home, inside and outside, as shown on the facility sketch is conducted. Staff and Children were spoken to during inspection. Licensee states there are no weapons or firearms in the home. There is an above ground pool at the home. The above ground pool has a mesh fencing around the pool that is locked with a wire and has a pool cover that is locked and has no ladder next to the pool making the pool inaccessible to day care children and meeting Title-22 regulations. LPA observed poisons, cleaning compound's, medications and other hazardous items are inaccessible to children. Fireplace is covered and is inaccessible to children. Fire extinguisher, Carbon Monoxide Detector and Smoke Detector meets regulations. Currently, licensee does have 1 rabbit. The rabbit is kept in a cage making the rabbit inaccessible to day care children. Stairs are barricaded when children under age 5 years old are present. There are gates at the top and bottom of the stairs. Toys and play equipment that were observed appear to be safe. There is a working telephone. Adequate supervision is being provided during this inspection. Children are supervised when outside in any unfenced play area. LPA reviewed sleeping plan for each infant under 12 months old present.
LPA reviewed 15 minute check log document.

The capacity as specified on the license is being maintained. (LARGE FCCH) Staff-child ratios are maintained. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Pediatric CPR/FA is current with expiration date of 10/2022. A child roster is maintained. Fire and disaster drills are conducted every six months and documented. Some children records reviewed.

Continue on 809 C
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2021
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: BILGI, AYSE & BILGI, AVNI
FACILITY NUMBER: 313622189
VISIT DATE: 07/19/2021
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LPA Owens discussed SB 277 (public health vaccination) and SB 792 (day care facilities: Immunization exemptions) with licensee at time of inspection. LPA observed proof that licensee and staff/ volunteers have met the requirements of SB 792.

LPA observed that all staff has completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com

This facility provides Incidental medical services-IMS. LPA reviewed the storage of medication and equipment /supplies, and reviewed children and personnel records. LPA discussed the need to create a plan of operation. Specifics on the plan can be found in the family child care home evaluator manual (FCCH EM) Policy 102417.



Off-limit rooms are: Garage and Master bedroom. Licensee acknowledges that children may never enter these off-limit areas. Observed tool shed in backyard and it locked by key lock. During the exit interview, LPA discussed AB 633, Parent Notification Requirements, and the posting of licensing inspection notices and reports. Hours of operation are 7:00 AM to 5:00 PM; Monday thru Friday and other hours as arranged. Licensee states she does not transport children.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, NO deficiencies are observed today. This report was reviewed and discussed
with licensee at time of inspection. Licensee have read and understands the content of this report.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
LIC809 (FAS) - (06/04)
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