013423843-1-31-2023-02-CC-ILOA-CNLRMR-20230131120911

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423843
Report Date: 01/31/2023
Date Signed: 01/31/2023 12:09:18 PM

Document Has Been Signed on 01/31/2023 12:09 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	ALEXANDER, LEANDRA		FACILITY NUMBER:	013423843
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS:	DATE:	01/31/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:58 AM
MET WITH:	Leandra Alexander		TIME COMPLETED:	12:16 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On January 31, 2023 at 8:58am Licensing Program Analyst (LPA) Indira Loza met with applicant Leandra Alexander to conduct an announced Pre-Licensing inspection. The home is occupied by the Applicant, the applicant's fingerprint cleared spouse, and the applicant's minor child age 11. The hours of operation will be 8am-6pm Monday through Friday. The home is a one story duplex consisting of three bedrooms, two bathrooms, a kitchen, a dining room, and a living room. The main daycare area will be the living room, dining room, and kitchen. There are three bedrooms and one bathroom in the hallway past the dining room. Access to the hallway is blocked with a baby gate. The Off Limit areas will be the Applicant's bathroom (the first door to the right from the hallway), the applicant's bedroom (second door on the right from the hallway), and the applicant's computer/gym room (first door to the left from the hallway). Applicant will ensure the off limit areas will be inaccessible by closed and/or locked doors, safety gates and visual supervision. The On Limit areas are the kitchen, bathroom next to the kitchen, dining room, second bedroom on the left from the hallway, and living room. The isolation area will be the second bedroom to the left from the hallway. There is no yard for outside play, instead the children will be taken to the Charlie Mini Door Park for outdoor play. The applicant plans on providing breakfast, lunch, and two snacks for the children. The applicant stated there are no firearms in the home. The applicant plans on having Liability insurance. LPA observed a working combined carbon monoxide and smoke detector. There is a working phone in the home. The home is sanitary and orderly, with heating and ventilation for safety and comfort. The applicant has a current Mandated Reporter Certificate which expires on October 7, 2024. Applicant has a current CPR/First Aid certificate which expires on August 6,2024. The applicant has a fully charged 2A10BC fire extinguisher. LPA discussed the safe sleep regulations with the Applicant, and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as *********************************************Report continues on 809-C*****************************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ALEXANDER, LEANDRA	FACILITY NUMBER: 013423843
	VISIT DATE: 01/31/2023

NARRATIVE

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an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Individual 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.

Effective today, January 31, 2023, The License for a small family daycare will be granted.
Exit Interview conducted and report reviewed with Leandra Alexander.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC809 (FAS) - (06/04)

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