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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700070
Report Date: 04/13/2021
Date Signed: 04/13/2021 12:30:48 PM

Document Has Been Signed on 04/13/2021 12:30 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:MACADAAN, JENNIFERFACILITY NUMBER:
015700070
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
04/13/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH:Jennifer Macadaan- LicenseeTIME COMPLETED:
12:45 PM
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On 4/13/21 at 12:17pm, Licensing Program Analyst (LPA) B.Plumboy conduct an Announced Case Management virtual Tele Visit inspection. LPA Plumboy and Licensee Jennifer Macadaan conducted a Facetime Meeting call. Licensee walked through her home and backyard showing her home by video to LPA Plumboy. Present during today's visit was 1 infant, 5 preschool age children, and licensee's fingerprint clear and associated mother Erlinda Abrigo. This facility currently operates from 6:00am until 6:00pm.

The home is two stories. The home consists of 3 bedrooms, 1 master bedroom/bathroom, 2 hallway bathrooms, a living room/dining room combo, garage, a kitchen, and a foyer. The home is clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the foyer, kitchen, garage, and entire second story of the home which will be inaccessible by closed and/or locked doors and visual supervision. As of 04/13/21, the downstairs bedroom located next to the bathroom is included in the ON LIMITS AREA. There is a child safety gate located at the base of the stairs to prevent access to children under the age of 5 years old. The children enter the home through the foyer, walk through the kitchen, and then enter into the childcare area. When the children walk through the foyer and kitchen they must be supervised at all times. There is a child safety gate located between the kitchen and dining room/living room combo. The ON LIMIT AREAS are the living/dining room combo, downstairs bathroom, and backyard section 1 which is located down 2 steps off the living room. The ISOLATION AREA will be a couch in the dining room. Outdoor play area will be in the fenced backyard. The outdoor play area has 2 sections. The section the children play in is backyard 1 which is located down 2 steps off the living room, and backyard 2 is off limits to children in care and located behind the fence. There are toys and learning materials present at the facility during today's inspection. There are no pools, hot tubs or any other bodies of water present on the premises during today's inspection. The home has a fully working smoke detector, working carbon monoxide detector, and working telephone. The applicant’s Health and Safety training is completed and CPR and First Aid certificate is current and expires 12/14/21. The applicant completed and received a certificate in mandated reporter training on 12/27/19.

There are no deficiencies cited during today’s inspection. This report shall remain on file for 3 years. A notice of site visit was emailed and must remain posted for 30 days. Exit interview conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2021
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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