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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624124
Report Date: 11/29/2021
Date Signed: 11/29/2021 09:58:43 AM

Document Has Been Signed on 11/29/2021 09:58 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:ROBINSON, ALANNAFACILITY NUMBER:
343624124
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 2CENSUS: 0DATE:
11/29/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Alanna RobinsonTIME COMPLETED:
10:15 AM
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On November 29, 2021 at 8:30 AM, Licensing Program Analyst (LPA) Tanya Washington met with Applicant, Alanna Robinson for an announced Pre-Licensing/ Change of location inspection. Applicant was previously licensed under facility #343621084. Applicant plans to operate Monday- Friday from 6 AM to 6 PM. Applicant and all adults residing in the home have received a criminal background clearance and are all associated to the facility.

LPA and Applicant toured the two story town house which has two bedrooms, two bathrooms, living room, dining room, kitchen and a patio. The townhouse is located on the premises of Deluxe Apartment Homes complex. Applicant and her spouse rent the home and control of property was provided with the application. Applicant does not have liability insurance and will have parents fill out an affidavit. The Applicant has received
Landlord consent which gives her permission to provide care up to eight children (age restrictions apply).

Off-limit areas will consist of entire second floor. Applicant understands that children may never enter the off-limits areas of the home. Applicant has a safety gate installed at the bottom of the stairs to prevent access to upstairs area. Applicant understands that when children under the age of five years old are present the gate must be installed. Applicant acknowledges she is required to notify licensing prior to making changes to off-limit areas so that they may be inspected for safety.

LPA observed a carbon monoxide detector, a functional smoke detector and a 2A10BC fire extinguisher. Hazardous cleaning products and chemicals, knives, and medications are all stored inaccessible to children. Applicant understands that poisons must be locked.

Continued on LIC809C
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2021
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: ROBINSON, ALANNA
FACILITY NUMBER: 343624124
VISIT DATE: 11/29/2021
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Applicant plans to take children on walks around the complex for outdoor play depending on the weather and the number of children. She is aware that 100% supervision must be maintained at all times when children are around bodies of water or in unfenced areas. Applicant stated there are no firearms in the home. There is an in-ground pool located on the premises of the complex which is fenced according to Title 22 regulations.

Applicant has completed the required EMSA certified CPR and First Aid class which is valid until 03/31/2022. Applicant has completed the required AB1207 Mandated Reporter Training which is valid until 11/14/2023. Applicant is registered to take the Preventative Health and Safety training on 01/22/2022.

LPA discussed current COVID-19 guidelines, postings, and protocols. LPA discussed Type A and Type B citations, Zero Tolerance, and Civil Penalties. LPA discussed open door policy, supervision, fire drills, children’s personal rights, reporting requirements, and the smoking prohibition with the applicant. A current roster of children enrolled must be available and maintained for a period of three years, even after children are no longer in care.

Annual fees must be paid promptly and by the due date or late fees will be assessed. Applicant understands that the license is non-transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. LPA explained to applicant that if she relocates and wants to continue to provide care, she must submit a change of location application and have the new home inspected.

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.

Continued on LIC809C

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
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: ROBINSON, ALANNA
FACILITY NUMBER: 343624124
VISIT DATE: 11/29/2021
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LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the applicant can request to be added to the distribution list to receive Quarterly Updates. LPA provided form LIC311D and discussed the required forms for children's records, employee records, and forms required to be kept on file at the facility. LPA provided the Licensing Agency website (WWW.CCLD.CA.GOV), so that the applicant may obtain updated licensing information, regulations, PINs, and forms.

Effective today, 11/29/2021, facility is issued a small provisional family child care home license to serve a capacity of 6 children with no more than 3 infants or 4 infants only. Or with a capacity of 8 children: no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6.

A regular license will be granted upon completion of Preventative Health and Safety training.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
LIC809 (FAS) - (06/04)
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