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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004849
Report Date: 02/17/2022
Date Signed: 02/17/2022 03:45:43 PM

Document Has Been Signed on 02/17/2022 03:45 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:LITTLE II, RICHARD C. & CAREY, PAIGE M.FACILITY NUMBER:
414004849
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
02/17/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Paige Carey, Robert LittleTIME COMPLETED:
03:45 PM
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Licensing Program Analysts (LPAs) Andrea Medlin and Hanson Leong met with applicants for this prelicensing visit. Purpose of visit explained. The Redwood City Fire Department has approved the fire clearance on 1/18/2022. Days and hours of operation will be Monday-Friday and hours will vary depending on schedule needs. Applicants states they and three minor children are the only ones who reside in the home. Control of property documents reviewed and are on file. Applicants advised that any person 18 years of age or older who lives here, or provides any care and supervision to daycare children, shall have criminal record clearance on file. The entire home is inspected for health and safety hazards. This is a one level home. The areas used for daycare will be: two primary rooms for daycare will be the front entry room and the living room/daycare room, bathroom down the hallway, dining area/kitchen, and the backyard. The kitchen has been child proofed including knobs on stove and locks on lower cabinets for toxics and sharp objects to be inaccessible to children. The off limits area will be: all three bedrooms and the garage. and living room. The home has smoke detectors, fire extinguishers, and carbon monoxide (CO) detectors. First aid kit/supplies are available. Applicants will use a separated area for isolation of ill/sick children which will be a corner in the living room until picked up by parent/guardian. Per applicant, there are two dogs in the home. Per applicants, there are no firearms or weapons in the home. No pools, spas, hot tubs, fish ponds, or similar bodies of water are present. Per applicants, they plan to purchase liability insurance for the child care. There are sufficient, age appropriate toys, and children's equipment available. Bathroom is clean and hazardous materials are inaccessible to children. Applicants advised to conduct emergency disaster drills at least once every six months and log the date and time of the drill. If applicant provides care to the 13th and 14th child, who must be school aged, parent notification and landlord consent is required. The following is required to be posted in an accessible location in view of parents: Emergency Disaster Plan (LIC 610), Parent's Rights (LIC 995A), and License (once received).

(continued on next page 809-C)
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2022
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: LITTLE II, RICHARD C. & CAREY, PAIGE M.
FACILITY NUMBER: 414004849
VISIT DATE: 02/17/2022
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This home meets the licensing requirements of a Large Family Child Care Home (FCCH) today and licensure is recommended and approved as of today, 2/17/2022.

This report is reviewed with applicants and a copy of this report must be made available for public review upon request. Records to be maintained were explained to applicant. Requirements regarding Unusual Incident Report were also discussed.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
LIC809 (FAS) - (06/04)
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