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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500218
Report Date: 03/27/2024
Date Signed: 03/27/2024 11:05:00 AM

Document Has Been Signed on 03/27/2024 11:05 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MOORE, KENNEISHAFACILITY NUMBER:
394500218
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 11CENSUS: 7DATE:
03/27/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Kenneisha MooreTIME COMPLETED:
11:20 AM
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On 03/27/24, Licensing Program Analyst (LPA) Elvira Sierra conducted a Case Management visit for the purpose of increasing capacity from 8 to 14 children and met with Licensee, Knneisha Moore. Fire safety inspection clearance was granted on 03/25/24 for a total capacity of 14 children. Licensee is requesting to change hours of operation. New hours of operation are Monday- Friday from 05:30 a.m.to 01:30 a.m., and Saturday from 05:30a.m. to 03:00 p.m. Licensee was advised never to exceed 24 hours of consecutive care. All individuals subject to criminal background review have obtained a criminal record clearance. Present in the facility was Licensee and two staff caring for 7 children.

A health and safety inspection of all areas accessible to children was conducted and the following was observed. Licensee is requesting to make second level off limits on today's inspection and add the side yard area of the house to the daycare area. New off limits areas are: Entire upstairs level, and garage. Licensee acknowledged that children may never enter these off-limit areas. Current CPR/First Aid certificates (expires: 08/06/25), posted License, Parent's Rights, Emergency Disaster Plan, Roster of the enrolled children, and Fire Drill Log are all being maintained by the Licensee. Hazardous items were stored inaccessible to children in care. A functioning telephone, fire extinguisher (2A10BC), carbon monoxide and smoke detector were observed. No bodies of water were observed in the premises. The licensee was advised that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes. Large capacity options were reviewed with the Licensee.
Capacity increase is approved as of today, March 27, 2024. The facility is licensed to serve a MAX. CAP(WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.
In the areas that were evaluated, no deficiencies were observed at the time of the visit. During the exit interview, the LICENSEE, Kenneisha Moore, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
Notice of site visit was posted and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee,Kenneisha Moore.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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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