343624130-3-15-2022-03-CC-JHOA-CCJPNC-20220315112745

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624130
Report Date: 03/15/2022
Date Signed: 03/15/2022 11:27:57 AM

Document Has Been Signed on 03/15/2022 11:27 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:	THOMPSON, EBONY		FACILITY NUMBER:	343624130
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	03/15/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Ebony Thompson		TIME COMPLETED:	11:45 AM

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	On 03/15/22, Licensing Program Analyst (LPA) Jan Hoshida met with Applicant Ebony Thompson for the purpose of a pre-licensing inspection. Individuals subject to criminal background review have obtained a criminal record clearance. During the inspection, LPA Hoshida requested a tour of the facility. LPA and Applicant conducted a health and safety inspection inside and out the home. The two-story home has an unfenced front yard, four bedrooms, two bathrooms, one master bathroom, kitchen open to the eating area and family room, front living room, garage, and fenced backyard. The off-limits areas in the home are the entire upstairs, kitchen, and garage. Off-limits areas will remain inaccessible to children by closed doors and/or supervision. Functioning smoke and carbon monoxide detectors were observed in the home. Current pediatric CPR and first aid training was verified and expires on 12/2022. The fireplace in the home is screened. Supervision was discussed and applicant understands that children must be 100% supervised in unfenced yards. Immediate Civil Penalty regulation and deficiencies were reviewed. Licensing documents were posted in the kitchen area of the home. Applicant stated there are no weapons in the home. Applicant will be offering day care services from Monday through Friday from 6:00 am to 6:00 pm. LPA did not observe a 2-A:10-B:C fire extinguisher in the home. Applicant stated that she has a 2-A:10-B:C fire extinguisher and submit proof to LPA. LPA consulted the applicant regarding personal rights. Applicant understands that corporal, physical and/or unusual forms of punishment is never allowed toward day care children or their own children during day care hours. *REPORT CONTINUED ON NEXT PAGE*

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Jan Hoshida
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

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: THOMPSON, EBONY	FACILITY NUMBER: 343624130
	VISIT DATE: 03/15/2022

NARRATIVE

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LPA consulted applicant regarding the following topics: Safe Sleep, Type A vs. Type B deficiencies, complaints, LPA’s right to interview children without parental consent, civil penalties, incidental medical services, placement of detergents, placement of poisons, placement of medicines, announced vs. unannounced inspections, posting requirements, unusual incident reports, on-limits vs. off-limit areas, licensing file management, fire drills, 80% supervision, 100% supervision, fingerprint clearances, advertising, mandated reporting, and best practices.

LPA discussed the Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care Home must have vaccinations against, Pertussis, Measles and Influenza. Proof of required vaccines have been obtained from the Applicant.

LPA explained the requirement of AB1207 Mandated Reporter training. LPA explained that training must be completed once every two years. LPA observed that Mandated Reporter training certificate is on file and was taken on 02/01/22.

Applicant understands that anyone living or working in the home, eighteen years of age or older must obtain fingerprint clearance PRIOR to living or working in the home. Applicant understands that if anyone else works with the children, must also obtain the following: EMSA certified CPR and first aid training if left alone with the day-care children, and immunization for Measles, Pertussis and Influenza, and complete AB1207 Mandated Reporter Training.

Applicant understands that a current roster must be maintained and that a fire drill must be conducted and documented once every six months.

Applicant understands that her FCCH license is not transferable, and once licensed, Applicant must live in the home and be present for 80% of the operating hours. LPA explained to Applicant that if she moves and wants to continue to provide care, she must submit a change of location application, and have the new home inspected again.

Applicant understands that if she wants to make any changes to on or off limit areas in the home, she must notify licensing and LPA must do an inspection BEFORE children are allowed in the areas.

REPORT CONTINUED ON NEXT PAGE

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Jan Hoshida
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

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: THOMPSON, EBONY	FACILITY NUMBER: 343624130
	VISIT DATE: 03/15/2022

NARRATIVE

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Applicant understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the written Unusual Incident Report (LIC 624) shall be submitted within seven days to remain in compliance.

LPA provided Applicant with Safe Sleep PIN 20-24-CCP and sleep logs for children under two years of age, reviewed Infant Individual Sleeping Plan (LIC 9227) for children under 12 months. LPA discussed current COVID-19 child care guidelines with Applicant.

Applicant understands that children’s records are to be maintained according to Title 22 Regulations and be accessible to licensing for up to three years. Licensee understands that her License, Emergency Disaster Plan, and the Parents Rights Poster must be posted in the home.

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.

LPA discussed the safe sleep regulations with applicant discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility plans to provide Incidental Medical Services – IMS. For IMS information , see PIN 22-02-CCP. 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

REPORT CONTINUED ON NEXT PAGE

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Jan Hoshida
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

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: THOMPSON, EBONY	FACILITY NUMBER: 343624130
	VISIT DATE: 03/15/2022

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LPA reviewed with applicant LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted

Entrance Checklist was provided to the applicant.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the applicant Ebony Thompson.

The following to be submitted prior to licensure:

· Proof of 2-A:10-B:C fire extinguisher within the home

Upon final review of file and proof of 2-A:10-B:C fire extinguisher within the home, facility will be approved for a Small 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, with landlord consent (LIC9149) for no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Jan Hoshida
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

LIC809 (FAS) - (06/04)

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