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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625093
Report Date: 07/18/2023
Date Signed: 07/19/2023 07:31:29 AM

Document Has Been Signed on 07/19/2023 07:31 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BAGCI, MUSAFACILITY NUMBER:
343625093
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/18/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Musa BagciTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Gagandeep Singh and Erwina Pascual-Golamco met with applicant, Musa Bagci for a scheduled pre-licensing inspection at the facility. Applicant lives in two story home with four minors. All the adults living in the house has criminal background clearance on file. All adults have criminal background clearance on file. Hours of operation will be Monday to Sunday 7:00 AM to 7:00 PM. Applicant owns the home and has provided the document of evidence of ownership. Child care will be provided on ground floor in areas: Living room, Dining area, Kitchen, Family room, Hallway, Bedroom in hallway, Bathroom in hallway and Backyard. Off limit areas: Entire second floor and Garage. All off limits areas must be made and remain inaccessible to children. Applicant was notified that prior to use of any off limits area, the department must be notified.

LPAs 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 off limit areas. The house has a working telephone, first aid supplies, carbon monoxide detector, fire extinguisher and smoke alarm. There is a variety of age appropriate toys available. As per the applicant, there are no firearms or weapons in the home. Fireplace is barricaded. There are no pools, spas or other bodies of water on the property. All of the unused electrical outlets have child protective covers installed. Applicant is informed 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.

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SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2023
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: BAGCI, MUSA
FACILITY NUMBER: 343625093
VISIT DATE: 07/18/2023
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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 certificate valid until December 2024 and Mandated reporter training certificate valid until October 2023. 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. LPA discussed the safe sleep regulations and provided copy of PIN 20-24-CCP. Smoking is prohibited in family child care homes. Licensee was informed about the Provider Information Notices (PINs) on CCLD website. The applicant is encouraged to frequently visit out website at 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.

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

Prior issue the license, applicant must apply cushion material to the furniture with sharp corners. Applicant will submit the proof of correction to the LPA and applicant's pending application will be forwarded to the Licensing Program Manager for final review.

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: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
LIC809 (FAS) - (06/04)
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