343624088-1-3-2022-03-CC-GSIH-CABVVL-20220103154632

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624088
Report Date: 01/03/2022
Date Signed: 01/03/2022 03:46:35 PM

Document Has Been Signed on 01/03/2022 03:46 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:	PRINCE, YULIWIANA		FACILITY NUMBER:	343624088
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	01/03/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Yuliwiana & Richard Prince		TIME COMPLETED:	04:00 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	Licensing Program Analyst (LPA) Gagandeep Singh met with applicant, Yuliwiana Prince, and her husband, Richard Prince, for a scheduled pre-licensing inspection at the facility. Applicant lives in a single story home. Proof of ownership has been provided. Hours of operation are Monday to Friday 7:00 AM to 5:30 PM. Child care will be provided in areas: Hallway, Dining room, Living room, Family room, Bathroom in the bathroom. Off limit areas: All bedrooms, Backyard, Garage and Patio area. All off limits areas must remain inaccessible to children. Isolation of an ill child will be in Living room. Applicant was notified that prior to use of any off limits area, the department must be notified. LPA Singh inspected the entire home with the applicant for health and safety hazards. The house has proper temperature and ventilation. All the toxic or dangerous materials are stored in garage and in off limit areas. Knives are stored on top of refrigerator and are inaccessible for children. All off limit rooms door knobs have child protective covers installed to keep them inaccessible for the children. Fireplace is barricaded. The house has a working telephone, fully charged 2A10BC fire extinguisher, smoke detector and carbon monoxide detector. There is first aid kit available. As per the applicant, there are no firearms or weapons in the home. Discipline policy will be timeout or talk to the child. Applicant was informed that time outs cannot be any longer than one minute per age of the child and can not exceed five minutes. Applicant is advised 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. See next page for continuation ...........

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022

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: PRINCE, YULIWIANA	FACILITY NUMBER: 343624088
	VISIT DATE: 01/03/2022

NARRATIVE

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LPA discuss licensing regulations and capacity requirements and a capacity worksheet was provided. Licensing forms and posting requirements were reviewed with the applicant. Applicant has submitted record of all the required immunization, CPR training valid until July 2023 and Mandated reporter training certificate. Applicant understands that fire/earthquake drills are to be conducted every 6 months and recorded. Applicant understands that baby walkers, bouncers, and excersaucers are not allowed. Smoking is prohibited in family child care homes. Licensee was informed about the Provider Information Notices (PINs) on CCLD website. LPA discussed the safe sleep regulation and provided a copy of PIN 20-24-CCP.

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 review AB 1207 with the applicant. As of January 1, 2018 all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.
Licensee has completed her training and the training is valid until July 26, 2023.The applicant is encouraged to frequently visit our website at http://www.ccld.ca.gov/ for licensing regulations and new updates. Applicant can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

Prior to issue license, facility needs to complete the following:
Obtain the criminal background clearance for applicant’s husband. He has been processed through live scan process and is waiting for the clearance.

Copy of this report was reviewed and provided to applicant. This report will be kept in the facility file and will be made available for public review upon request. Desk Duty is available Monday through Friday between 8 AM - 5 PM at (916) 263-5744.

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022

LIC809 (FAS) - (06/04)

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