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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500724
Report Date: 10/12/2022
Date Signed: 03/19/2024 10:11:30 AM

Document Has Been Signed on 03/19/2024 10:11 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:LEVINGSTON, JA'NAYFACILITY NUMBER:
394500724
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/12/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Ja"nay LevinsgtonTIME COMPLETED:
10:30 AM
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This is an amended version of a report originally signed on 10/12/22.
On Wednesday, October 12, 2022, Licensing Program Analyst (LPA) Elvira Sierra met with the applicant, Ja'nay Levingston for the purpose of a change of location. Previously, the applicant was licensed (394500406) at a different location and has recently moved to current location. Facility is a one story 3 bedrooms 2 bathrooms house. Per Licensee hours of operation will be M-F 24 hours a day. Applicant was advised never to exceed 24 hours of consecutive care.

LPA inspected all areas of the home for health and safety. Off-limit areas are; All bedrooms, Living Room, Garage, front yard, driveway, left and right side of the backyard. The licensee acknowledged that children may never enter these off-limit areas. Adult residents have criminal record clearances. LPA observed current CPR/First Aid certificates (expires 04/2023). License, Parent's Rights, and current Emergency Disaster Plan were observed posted. Safe toys and comfortable accommodations were observed. The applicant stated there are no weapons in the home. Home was observed to have a 2A:10-BC fire extinguisher, a working telephone, smoke, and carbon monoxide detectors. Cleaning compounds and hazardous materials are inaccessible to children. There are no bodies of water in the home. The backyard is fenced for supervision. The license acknowledges children must be 100% supervised in unfenced areas or during water activities. LPA received LIC 9151 (Landlord Notification) on today's inspection visit.

Effective today, October 12, 2022, the facility is licensed to serve a MAX. CAP: 6 - NO MORE THAN 3 INFANTS OR 4 INFANTS ONLY. Applicant understands if Landlord consent is obtained (LIC 9149) the capacity License will be -CAP 8 - NO MORE THAN 2 INFANTS, 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

Exit interview was conducted and the report was provided and reviewed with Licensee, Ja'nay Levingston.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2022
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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