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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500484
Report Date: 11/17/2021
Date Signed: 11/17/2021 12:10:20 PM

Document Has Been Signed on 11/17/2021 12:10 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:ROGAN, TANISHAFACILITY NUMBER:
394500484
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/17/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Tanisha RoganTIME COMPLETED:
12:20 PM
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On 11/17/2021 at 9:55 AM Licensing Program Analyst (LPA) Jeevun Birk-Miller conducted a pre-licensing inspection and met with applicant, Tanisha Rogan. All individuals subject to criminal background review have obtained a criminal record clearance. The applicant was reminded that all adults 18 and over living or working in the home, 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.

A health and safety inspection was conducted inside and out. The two story home has four bedrooms, three bathrooms, a living room, kitchen/dinning area, shed and fenced backyard. The off-limit areas in the home are: entire upstairs. Off-limits areas will remain inaccessible to children by closed doors and/or supervision. The applicant acknowledges that she must contact LPA prior to making an off-limits area on-limits and vice versa. Toxic and hazardous items are inaccessible to children. Functioning smoke and carbon monoxide detectors were observed in the home. LPA observed a 2-A-10-BC fire extinguisher.

Preventative health and current pediatric CPR and first aid training was verified and CPR expires 06/2022. Mandated Reporter Training certificate was observed and expires 12/08/2022. There are no bodies of water on the premises. The applicant stated there are fire arms in the home and the LPA observed the storage to meet Title 22 Regulations. Applicant was encouraged to maintain supervision at all times. LPA provided information about Type A/B citations and civil penalties.

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. Report continued on 809-C...
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Jeevun Birk
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2021
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: ROGAN, TANISHA
FACILITY NUMBER: 394500484
VISIT DATE: 11/17/2021
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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 .

This facility evaluation report was reviewed and discussed with the applicant. LIC 311D, records, postings, and reporting requirements were discussed. LPA discussed supervision, personal rights, criminal record clearances, staffing ratios and capacity, and maintaining buildings and grounds. Applicant was encouraged to visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

Effective today, 11/17/2021, this home is licensed for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.

An exit interview was conducted. A copy of this report was given to the Applicant to keep on file at the facility.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Jeevun Birk
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021
LIC809 (FAS) - (06/04)
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