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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500599
Report Date: 06/06/2022
Date Signed: 06/06/2022 03:40:08 PM

Document Has Been Signed on 06/06/2022 03:40 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:KEMOKAI, RASHIDIFACILITY NUMBER:
344500599
ADMINISTRATOR:KEMOKAI, RASHIDIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 513-9610
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/06/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Rashidi KemokaiTIME COMPLETED:
04:00 PM
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On 06/06/2022 at 12:45 AM, Licensing Program Analyst (LPA) Katy Maestas and Licensing Program Manager Sharon Ogbodo met with Applicant Rashidi Kemokai (A1) for the purpose of a prelicensing inspection. In preparation for this field visit, LPA conducted a file review on 06/03/2022. Upon arrival, LPA disclosed the purpose of the inspection and was granted entrance into the FCCH on 06/06/2022. All individuals subject to criminal background review have obtained a criminal record clearance verified by LPA accessing Guardian. Licensee’s tentative hours of care are Monday-Friday, from 6:00 am to 6:00 pm.

A health and safety inspection was conducted inside and outside of the home. A1 accompanied LPA for the entirety of the tour. The FCCH contains three levels: lower level, first level and upper level. The lower level of the home has a living room, bathroom, bedroom, laundry room and access to the garage. The first floor of the home has a kitchen, dining room and a play room. The upper level of the home has a master bedroom and bathroom, 2 bedrooms, and a bathroom. The off-limits areas in the home are the upper level, garage, laundry room, and side yards.Off-limits areas will remain inaccessible to children. The outdoor play area was toured and no pool, spa or water feature was observed by LPA. LPA verified toxic and hazardous items were inaccessible to children in care. Cleaning chemicals and compounds were stored in the laundry room and out of reach of children on a top shelf. A1 stated that she does not have any poisons but understands that poisons are to be stored behind lock and key.

Functioning smoke and carbon monoxide detectors were observed in stairwell. LPA suggested that the fireplace in the living have a baby gate or protective barrier. A 2A10BC fire extinguisher was observed hanging by the front door. A first aid kit was observed also near the front door. A1 stated there are no weapons in the home.



LPA discussed Mandated Reporter Training with the A1. Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Continued on 809-C
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2022
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: KEMOKAI, RASHIDI
FACILITY NUMBER: 344500599
VISIT DATE: 06/06/2022
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This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English. Applicant has a current Mandated Reporter Training Certificate which will expire on 03/28/2024. Current Pediatric CPR and First Aid training was verified and expires on 11/20/2024.

LPA discussed the Safe Sleep Regulations with A1 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 A1 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.

Incidental Medical Services (IMS) policy was discussed with A1. 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)/ (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



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.

Continued on 809-C

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2022
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: KEMOKAI, RASHIDI
FACILITY NUMBER: 344500599
VISIT DATE: 06/06/2022
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A1 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.

A1 understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. A1 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. A1 understands that if any structural changes are made to the home; licensing must be notified PRIOR to construction.



A1 understands that if she wants to make any OFF-limit area an ON-limit area, she must notify licensing and LPA must do an inspection BEFORE children are allowed in the area. A1 understands that children’s records are to be maintained according to Title 22 regulations and be accessible to licensing for up to 3 years.

LPA reviewed with A1 LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. The Entrance Checklist was provided to the applicant.

As of today, 06/06/2022, Licensee cannot be approved for a Large Family Child Care Home license. To obtain a license, the following is required: stairs separating lower level and first level must be barricaded with a baby gate, the back yard must be clean and cleared from small items and debris, and side yard (near kitchen) must be blocked off. A1 will contact LPA within 30 days to schedule a follow-up inspection.

An exit interview was conducted with A1 and Appeal Rights were provided.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2022
LIC809 (FAS) - (06/04)
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