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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627112
Report Date: 05/23/2023
Date Signed: 05/23/2023 11:52:28 AM

Document Has Been Signed on 05/23/2023 11:52 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:JERRY, BELINDA FAMILY CHILD CAREFACILITY NUMBER:
376627112
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
05/23/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Belinda Jerry TIME COMPLETED:
12:01 PM
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On 05/23/2023 at 10:45am, Licensing Program Analyst (LPA) David Miller conducted an unannounced case management inspection for the purpose of a capacity increase from a small to a large license. LPA met with the licensee, who was on site with two staff and four children (two infants and two preschool age kids)

On 02/10/2023, Licensee submitted an application (LIC 279) requesting a capacity increase. The Fire Safety Inspection Request (STD 850) was approved for fourteen (14) children on 05/16/2023.

This facility is a two (2) story, three (3) bedroom, two (2) bathroom house. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are family room, kitchen, bathroom and the backyard. Off limits areas include bedroom 1, 2, and master bedroom and bathroom and are inaccessible through use a baby safety gate. Licensee states she will utilize fenced backyard for outdoor activities. Licensee was reminded that continuous supervision is to be given to children whenever engaged in outdoor activities. The hours of operation are Monday through Friday from 6am to 6pm. Licensee stated she will notify the Department of any changes in the hours of operation.

The fire extinguisher is rated 2A 10B: C. and is in the kitchen mounted on the kitchen wall. The smoke/carbon monoxide detector meets requirements and is operational. LPA observed that the home has sufficient space, toys, and equipment available for children’s use.

Licensee’s First Aid and CPR certifications expire on August 2023. Licensee has required immunizations. Licensee completed the mandated reporter training on 03/21/2022 . The facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented on 05/22/2023. Licensee stated there are no bodies of water on the premises, and no weapons or ammunition in the facility. LPA observed no bodies of water during the inspection.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2023
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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JERRY, BELINDA FAMILY CHILD CARE
FACILITY NUMBER: 376627112
VISIT DATE: 05/23/2023
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The Licensee was provided with the Ratio/Capacity Worksheet for a large family childcare home. The Licensee acknowledged that if no assistant provider is present at a Large Family Child Care Home, then the Licensee shall comply with the capacity requirements for a Small Family Child Care Home. Licensee stated that she does not have property owner landlord consent (LIC-9149) to care for 14 children. Licensee stated that she will only care for 12 children at this time.

The Licensee is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. Duty Line was provided: (619) 767-2248. Southern California Child Care Advocate (SCCCA) information was provided. The Licensee is already enrolled in this program’s email
email list through the CCLD website, thus receives updated regulation information. Advocate information was provided: (916) 654-1541 and childcareadvocatesprogram@dss.ca.gov

A large license may be issued after a final file review. No deficiencies cited during today’s inspection on this date.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Licensee Belinda Jerry.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023
LIC809 (FAS) - (06/04)
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