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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623605
Report Date: 07/19/2022
Date Signed: 07/19/2022 10:48:42 AM

Document Has Been Signed on 07/19/2022 10:48 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:COLLINS, DOMINIQUE & DAY, JALISAFACILITY NUMBER:
343623605
ADMINISTRATOR:COLLINS D/DAY JALISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 283-3236
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
07/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Dominique Collins & Jalisa DayTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Gagandeep Singh met with both of the licensees, Dominique Collins and Jalisa Day , for an annual inspection. The purpose of the inspection was explained. Licensees live in a single story home. Present, there are six children in care. All adults living or working in the home have criminal background check on file. Licensee is operating within the capacity of this date. Licensee provides day care from Monday to Friday between 7 AM to 4:30 PM.

LPA inspected the day care areas with the licensee. Day Care Areas: Living room, Kitchen, Hallway, Bathroom in hallway, right Bedroom at end of hallway and Backyard. Off limit areas: Master bedroom, Bedroom next to entrance and Garage. There is no pool, spa or any other body of water in the house. As per licensee, there is no firearm or weapon in the house. All the cleaning supplies, poisons and other chemicals are stored inaccessible to the children. Cabinets in kitchen have child protective locks installed. Fireplace has metal screen protector in place. The house is in good repair and free of hazards with proper temperature and ventilation. There are multiple carbon monoxide detectors and smoke detectors in the house. The house also has pull fire alarm installed. There is fully charged fire extinguisher, first aid supplies and working telephone available in the house. There is a variety of age appropriate toys in the house. All of the unused electrical outlets have child protective covers installed. Licensees have changing table available in the house.

During inspection, LPA reviewed the facility records. LPA observed licensee has License and other required documents posted in the child care areas. Both of the licensees have record of training of preventive health and CPR card valid until March 2023. Licensees have a log in place for fire drills and per log, last drill was conducted on July 05, 2022. LPA also reviewed the present children's record. LPA reviewed the identification and emergency information form for every child for proper names and numbers filled. Licensee has record of immunization of each child in care. See next page for continuation ............
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2022
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: COLLINS, DOMINIQUE & DAY, JALISA
FACILITY NUMBER: 343623605
VISIT DATE: 07/19/2022
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The facility has an updated children roster on file. Licensees are aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed licensees have completion certificate on file and per certificate, the training is valid until July 05, 2024.

LPA reminded the licensee that all adults, 18 years and older living in the home, helper or assistant must have criminal record clearance and must be associated to the facility by submitting an LIC 9182 with copy of CA DL or CA ID prior to having any contact with children in care. Failure to do so could result in an immediate civil penalty of $100.00 each day.

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

LPA encourage the licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.



No deficiencies are cited today. The copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022
LIC809 (FAS) - (06/04)
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