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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455407991
Report Date: 10/04/2021
Date Signed: 10/04/2021 03:51:02 PM

Document Has Been Signed on 10/04/2021 03:51 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:HAGERMAN, JAMIELYN FAMILY CHILD CARE HOMEFACILITY NUMBER:
455407991
ADMINISTRATOR:HAGERMAN, JAMIELYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 515-5280
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
10/04/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Jamielyn HagermanTIME COMPLETED:
09:55 AM
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A change of location pre-licensing inspection was conducted today by Licensing Program Analyst (LPA) Mendez. The licensee is requesting a license for a capacity of 14 in her new residence. Services will be provided Mon-Fri 7:00am -6:00pm. The residence is a four bedroom, two bathrooms. There are one adult and five minors living in the home. All adults residing in the home or working with children have criminal background clearances on file with the Department.

Children will have access to the daycare room, kitchen, living room, dining room, one bedroom, bathroom and laundry room will be accessible so that children can hang their backpacks and laundry room is next to entrance of front door. The licensee understands any changes to the use of the home shall be reported to the Department with an updated floor/yard plan. The home is clean and orderly at this time and will remain so during child care hours. There is a working telephone. The sharp knives, cleaning supplies and medicines, are stored out of the reach of children. There are no firearms in the home. The children in care will have access to age appropriate toys and equipment. The home is equipped with a working smoke detector, carbon monoxide detector and fire extinguisher rated at least 2A10BC. Children will use the front yard as the outdoor play area and it is not fully fenced. The licensee understands that complete supervision is required when the children use the front yard as a play area. Poisons are not stored at the home. The licensee understands that items that could pose a danger to children shall be made inaccessible to children. There were no bodies of water observed.

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SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2021
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: HAGERMAN, JAMIELYN FAMILY CHILD CARE HOME
FACILITY NUMBER: 455407991
VISIT DATE: 10/04/2021
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The licensee is not providing Incidental Medical Services – IMS, at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan for Providing IMS must be submitted to the Department if IMS is provided. 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: www.ada.gov/childqanda.htm. The licensee possesses current pediatric CPR and First Aid certification and expires 12/2021. Licensee has Licensee's mandated reporter training expires on 9/2022. The licensee understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice. This report was reviewed and discussed with the licensee. New Infant Regulations and Guide to Safe Sleeping Practices was discussed. Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

Notice of Site Visit shall be posted for 30 days from today's visit.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021
LIC809 (FAS) - (06/04)
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