343624988-6-27-2023-03-CC-AMAT-CT7RQV-20230627131410

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624988
Report Date: 06/27/2023
Date Signed: 06/27/2023 01:14:33 PM

Document Has Been Signed on 06/27/2023 01:14 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	JONES, STARR		FACILITY NUMBER:	343624988
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	06/27/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Starr Jones		TIME COMPLETED:	12:25 PM

NARRATIVE

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On Thursday June 21st, 2023 at 9:00 AM, Licensing Program Analyst (LPA) Arianna Manabat met with Applicant Starr Jones for the purpose of an announced pre-licensing inspection. During today’s visit one child was present in the home. All individuals subject to criminal background review have obtained a criminal record clearance. Applicant plans to operate Monday through Friday from 6:00AM-6:00PM. Applicant plans to watch children ages: Birth to school age.

A health and safety inspection was conducted inside and outside the home. The home is a two story home with a living room, three bedrooms, kitchen/dining room, three bathrooms, loft, and garage. Off-limit areas will include: the downstairs closet, garage, and entire upstairs area. Applicant understands that children may never enter these off-limit areas. Toxic and hazardous items are inaccessible to children and out of children’s reach. Sharp knives are stored in the kitchen in an area that is inaccessible to children.

Children’s medications will be stored in an area inaccessible to children. A functioning smoke detector, carbon monoxide detector, and fire extinguisher was observed in the home. Applicant stated that there are no weapons or bodies of water in the facility. LPA discussed all required licensing postings. Applicant has completed the required Preventative Health and Safety course with the Lead Poisoning Prevention training. Current EMSA approved pediatric CPR/First Aid training was verified and kept on file.

Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

Continued on LIC 812C…………

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: JONES, STARR	FACILITY NUMBER: 343624988
	VISIT DATE: 06/27/2023

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Continued from LIC 812…………….
Applicant has completed a Mandated Reporter Training. The Applicant was encouraged to maintain supervision at all times. LPA discussed requirements for staff, adult assistants, and adults living in the home. Type A/B citations and Immediate Civil Penalty regulation deficiencies were reviewed. 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 Unusual Incident Report LIC 624 shall be submitted within 7 days to remain in compliance. 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.

Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. LPA reviewed with applicant the 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.

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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (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 LIC 812 C...............

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: JONES, STARR	FACILITY NUMBER: 343624988
	VISIT DATE: 06/27/2023

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Page 3: LPA discussed the safe sleep regulations with applicant and 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 of 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.
On this date, 06/27/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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 platforms. 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. Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

A 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. The Sacramento Regional Office is available Monday through Friday between 8 AM - 5 PM at (916) 263-5744.

DURING TODAY'S VISIT THE FACILITY IS LICENSED FOR: MAX. CAP: 6 - NO MORE THAN 3 INFANTS OR 4 INFANTS ONLY. CAP 8 - NO MORE THAN 2 INFANTS, 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6. LANDLORD CONSENT WAS OBTAINED FOR 8 CHILDREN. 6 CHILDREN IS THE CURRENT MAX CAPACITY. OFF-LIMITS areas include: THE DOWNSTAIRS CLOSET, GARAGE, AND ENTIRE UPSTAIRS AREA.

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

LIC809 (FAS) - (06/04)

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