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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409721
Report Date: 10/10/2024
Date Signed: 10/10/2024 03:41:05 PM

Document Has Been Signed on 10/10/2024 03:41 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:WAGNER, JANNIKAFACILITY NUMBER:
073409721
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
10/10/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:WAGNER, JANNIKATIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On October 10, 2024 at 1:25PM Licensing Program Analyst (LPA) Nyeesha Blount conducted an unannounced case management visit for change of location. LPA met with Applicant Wagner, Jannika who is background cleared (1) minor child (1) infant were present during today's inspection. LPA toured the home with Applicant for a Health and Safety inspection. Applicant has applied for a Change of Location for a Small Family Child Care Home with capacity for 8 children. Hours of operation will be Sunday through Friday from 9:00 PM - 7:00 PM. The home is a Two story duplex which consist of (3) bedrooms, (1) bathroom, living room (day care room), kitchen, street parking, and fenced back yard. All required postings are posted to the right of the living room on the wall. Applicant has a fully stocked first aid kid. Applicant has current mandated reporter training which expires on 08/29/26. Isolation of sick child will be on the futon in the living room. Applicant understands that 100% supervision is required at all times. Applicant applied for change of location for better business opportunties. The home is neat and clean and has central heating and ventilation for safety and comfort. There are sufficient age appropriate furnishings, toys, books and learning materials available. Licensee states that there are no weapons in the home. All hazardous materials and toxins are stored away inaccessible to children in care at the time of the inspection. The home is equipped with a 2A10BC fire extinguisher, working smoke detector, and working carbon monoxide detector. Pediatric CPR and First Aid are current and will expire on September 15, 2026.

ON LIMIT AREAS: Living room (daycare room), (1) bathroom, and fenced backyard.

OFF LIMIT AREAS: (3) bedrooms, and kitchen of the home secured with gates made inaccessible to children in care.

Licensed effective 10/10/24
There are no deficiencies cited today. An exit interview was conducted. Appeal rights were given and discussed. A site visit notice was given and posted.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
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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