073408970-9-30-2022-02-CC-CWAS-CJS2BN-20220930171525

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408970
Report Date: 09/30/2022
Date Signed: 09/30/2022 05:15:39 PM

Document Has Been Signed on 09/30/2022 05:15 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:	LEE, JASMINE		FACILITY NUMBER:	073408970
ADMINISTRATOR:	LEE, JASMINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 414-3163
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/30/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Jasmine Lee		TIME COMPLETED:	05:00 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 09/30/2022 at 2:10 PM, Licensing Program Analyst (LPA) Christina Watts conducted an unannounced annual inspection for Jasmine Lee's large family child care home. LPA met with licensee and guided analyst on a tour of the facility. During today's inspection, there were no children in care and no children enrolled. In the home during inspection was licensee's 3 minor children and licensee's school age nephew. Family members residing in the home are licensee, the licensee adult child, and licensee 3 minor children ages 9,7 and 6 years old. Facility hours of operations are Monday - Friday from 6:00 AM - 7:00 PM. Licensee adult child currently lives in the home however does not currently have criminal background clearance and is not associated to the home. As of January 2022, licensee has not been caring for children. LPA reminded licensee all adults 18 and over living in the home must obtain a criminal record clearance. This is a two story home which consists of 4 bedrooms, 2 1/2 bathrooms, kitchen, dining room, living room, laundry room, family room, attached garage, backyard with an fenced swimming pool, jacuzzi, and shed which is made inaccessible. Licensee stated they wanted the Laundry Room to be an on limit area for children due to the half bathroom is inside of Laundry Room. The children on limits areas: Living room, Den (Child care area), Family Room, Bathroom, Laundry Room. Areas off limits include: Entire second floor which includes 4 bedrooms, 2 bathrooms, kitchen, entire backyard which has fenced swimming pool and jacuzzi with shed and attached garage. The LPA toured all areas used by children during this visit.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: LEE, JASMINE	FACILITY NUMBER: 073408970
	VISIT DATE: 09/30/2022

NARRATIVE

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Per licensee, there are weapons or firearms in the home. Licensee has an up to code 2A10BC fire extinguisher and working smoke/carbon monoxide detector on the premises. LPA observed a screened fireplace in the living room. Licensee last conducted fire drill 06/21/2021. LPA reminded licensee the importance of conducting a fire/earthquake drill every six months. LPA observed one dog in the facility.

LPA inspected the backyard and observed a fenced swimming pool and jacuzzi with a shed. Backyard is currently off limits to children in care however LPA discussed when backyard becomes in use for children in care, that there needs to be 100% supervision when children are playing in the backyard

Facility does provide transportation for children and understands that children cannot be left alone, unattended in parked vehicles

No children’s records were reviewed due to no children currently in care. The licensee Pediatric First Aid and CPR certificate will expire in 07/2024. Required postings were observed near the entrance.

LPA reminded licensee day care needs to be operated within the limitations and capacity of a Large Family Child Care Home with regards to ratios and that Licensee has to be present in the day care for 80% of the operation hours.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and central heating system for safety and comfort. There were safe toys, play equipment and materials observed for children. There are stairs in the home that are made inaccessible for children in care. There is a working telephone in the home. Detergents, poisons, cleaning compounds, medications, and other items which can pose a danger to children are made inaccessible in the home.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

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: LEE, JASMINE	FACILITY NUMBER: 073408970
	VISIT DATE: 09/30/2022

NARRATIVE

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Incidental 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. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

On or before March 30, 2018, any person who works in a child care facility shall complete Mandated Reporter training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers. Licensee has provided Mandated Reporter certificate and the certificate will expire 08/2023.

Licensee 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

As of 09/30/2022, the Laundry room is now an in use are for children.

In the areas that were evaluated, there were no violation observed.

Exit interview conducted and report was reviewed with the licensee, Jasmine Lee. A notice of site visit was given and must remain posted for 30 consecutive days.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

LIC809 (FAS) - (06/04)

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