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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409328
Report Date: 10/05/2022
Date Signed: 10/05/2022 01:55:47 PM

Document Has Been Signed on 10/05/2022 01:55 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:COLLINS, JANELLFACILITY NUMBER:
073409328
ADMINISTRATOR:COLLINS, JANELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 436-3720
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
10/05/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:27 PM
MET WITH:Janell CollinsTIME COMPLETED:
02:15 PM
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On October 5, 2022, at 12:27PM, Licensing Program Analyst (LPA) Indira Loza met with Licensee Janell Collins for an announced change of location inspection. Present for this inspection was the Licensee, Licensee's two adult sons, the Licensee's three underage children. The home was inspected with the Licensee to conduct a Health and Safety Inspection. Operating hours will be Monday through Friday from 6:00AM to 6:00PM.

The home is a two story home consisting of six bedrooms and four bathrooms. The daycare will be operating on the first floor which is neat and clean with heating and ventilation for safety and comfort of the children. The first floor of the home consists of two bedrooms, a living room, dining room, kitchen, family room, and two bathrooms. There is also a fully fenced in backyard. The OFF LIMIT AREAS are the entire second floor, the two bedrooms on the first floor, the bathroom in the hallway next to the bedrooms on the first floor, and front yard of the home which will be inaccessible by closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the bathroom on the left from the main entrance, the dining room, the living room, the kitchen, and the backyard. The ISOLATION AREA will be the sofa in the living room. The outdoor play area will be the backyard. There are ample age appropriate toys that are safe and appear to be clean and in good repair. There is an above ground pool on the left side of the backyard with a sturdy pool cover, the above ground pool is approximately 4.5 feet high with the ladder stored separately. LPA did not observe any hazardous materials or toxins accessible to children today.

The home has a fully charged 4A60BC fire extinguisher, working smoke detector, a working Carbon Monoxide detector, a working telephone, and fully stocked First Aid Kit.The Licensee's CPR and First Aid certificate is current and expires on November 2022. Per Licensee, there are no firearms in the home. The Licensee is the home owner.
******************************************Report Continues on LIC 809-C*****************************************
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2022
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: COLLINS, JANELL
FACILITY NUMBER: 073409328
VISIT DATE: 10/05/2022
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The licensee was reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.

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) 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

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.

License for a Change of Location will be granted, effective today, October 5, 2022


Exit interview conducted and report was reviewed with Licensee Janell Collins.

Exit interview conducted
Report and Appeal Rights provided.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022
LIC809 (FAS) - (06/04)
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