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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625612
Report Date: 12/04/2023
Date Signed: 12/04/2023 11:10:45 AM

Document Has Been Signed on 12/04/2023 11:10 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:GHEBRETINSAE, LULAFACILITY NUMBER:
343625612
ADMINISTRATOR:GHEBRETINSAE, LULAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 910-7823
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/04/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lula GhebretinsaeTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Gagandeep Singh met with applicant, Lula Ghebretinsae, for a scheduled pre-licensing inspection at the facility. Applicant lives in a single story family home. Applicant has provided copy of ownership of the property. Child care will be provided in areas: Living room, Room # 1, Kitchen, Dining area, Hallway, Bathroom in hallway, Room # 3, Bathroom connected with Room # 3, Room # 2 and Backyard. Off limit areas: Laundry room and Garage. Applicant understands that all off limits areas must remain inaccessible to children. Applicant was notified that prior to use of any off limits area, the department must be notified. The house was inspected by the local fire department and the clearance was granted.

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 off limit areas or in cabinets with locks. Cabinets in kitchen have child protective locks installed. Per applicant, there are no fire arms or weapons in the house. The house has a working telephone, multiple smoke detectors, fully charged 2A: 10BC fire extinguisher, pull alarms and carbon monoxide detectors. Kitchen stove has child protective plastic covers on the control knobs. There is a variety of age appropriate toys available. All unused electrical outlets have child protective covers installed. Fireplace is barricaded with furniture. There are no stairs in the house. Applicant has a changing table in the Room # 3. LPA informed the applicant about the requirements of having cribs or play yard for any child under age of two years old. There is inground pool in the back yard. By using measuring tape, it was found that the fence around pool is 5 feet 2 inches high and has left latching gate with lock.


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SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: GHEBRETINSAE, LULA
FACILITY NUMBER: 343625612
VISIT DATE: 12/04/2023
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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. Applicants has submitted record of CPR training valid until November 2025 and Mandated reporter training certificate valid until November 10, 2025. 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.

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.

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.

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. 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-carelicensing/subscribe and select the Child Care option to receive email communication. See next page for continuation .......
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: GHEBRETINSAE, LULA
FACILITY NUMBER: 343625612
VISIT DATE: 12/04/2023
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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-andresources/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.

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.

During today's inspection, LPA did not observe any hazard in the house. Applicant has submitted all of the required documents to the department. Therefore, the applicant will be granted the license for large Family Child Care Home with maximum capacity of fourteen children in care.

Exit interview conducted and report was reviewed with the applicant, Brittney Rachelle Seely. 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: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023
LIC809 (FAS) - (06/04)
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