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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409069
Report Date: 04/26/2021
Date Signed: 04/26/2021 11:32:27 AM

Document Has Been Signed on 04/26/2021 11:32 AM - 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:COLLINS, JANELLFACILITY NUMBER:
073409069
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
04/26/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:JANELL COLLINSTIME COMPLETED:
11:30 AM
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10:00AM, Licensing Program Analyst Alexander met with licensee Janell Collins for an announced INCREASE OF CAPACITY inspection via Face-time call due to the COVID-19 pandemic. Present for the inspection were licensee, assistant Annie Travis, and 5 children in care, consisting of 1 infant, and 4 school age. 3 of the children present today are the licensee's own children. LPA virtually toured the facility and backyard for a health and safety inspection. The children's files was not reviewed today. The home is equipped with a 2A10BC fire extinguisher, working smoke detector and working carbon monoxide detector. There is a working telephone in the home. Per licensee, there are no fire arms located on the premises. There are no pools, hot tubs, or other bodies of water at the home. All poisons, cleaning solutions and medications are inaccessible to children in care. Licensee has current CPR and 1st Aid training which includes nutrition and lead poisoning training, expires 11/26/2022 respectively. The off limits areas are the garage and the entire upstairs which includes all 4 bedrooms, and 2 bathrooms. These areas will be inaccessible to children in care by closed/and or locked doors, visual supervision and a safety gate at the bottom of the stairs. Licensee was also informed of the licensing web address (www.ccld.ca.gov) for downloading child care forms and (www.myccl.com) to register to receive child care updates.
A review of staff records on 10/25/18 indicates that all facility staff or other individual who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.


Effective September 1, 2016, a person may not work or volunteer at a child care center or family child care home unless he or she has been vaccinated against pertussis, measles and influenza or has an exemption. Today licensee has immunization records in file and all are up to date.

The newly implemented mandatory mandated reporter training course was also discussed today. Licensee has a certificate of completion and is up to date.

CONTINUED ON 809-C

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2021
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: COLLINS, JANELL
FACILITY NUMBER: 073409069
VISIT DATE: 04/26/2021
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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. 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: http://www.ada.gov/childqanda.htm

ALL COVID-19 POSTINGS WERE OBSERVED AND POSTED. THE SELF-ASSESSMENT GUIDE HAS ALSO BEEN RECEIVED AND IS IN FILE.


As a result of this visit, there are no deficiencies cited today. An exit interview was conducted This report must be available for public review for 3 years.

THIS HOME WILL BE LICENSED FOR A LARGE FAMILY CHILD CARE HOME EFFECTIVE TODAY 4/26/21.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2021
LIC809 (FAS) - (06/04)
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