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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010033
Report Date: 05/21/2021
Date Signed: 05/24/2021 02:39:38 PM

Document Has Been Signed on 05/24/2021 02:39 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:BOHAN, NAHANI FCCHFACILITY NUMBER:
173010033
ADMINISTRATOR:BOHAN,NAHANIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 287-0551
CITY:KELSEYVILLESTATE: CAZIP CODE:
95451
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/21/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Nahani BohanTIME COMPLETED:
11:00 AM
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The facility inspection was conducted via tele-inspection due to the Covid-19 state of emergency pandemic. The department has suspended all field operations and the applicant has agreed to conduct the video conference with LPA, (Licensing Program Analyst) Glenn Ouye. A follow-up, in-person site visit may be conducted at a later date.

An application was submitted to the department to operate a family child care home on January 12, 2021. Services will be available Monday through Friday, 08:00 AM - 5:00 PM. The applicant understands that 24hr consecutive care is prohibited. The residence has three bedrooms, two bathroom and is a single level home. There are presently two adults living in the home. The applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance.

The floor and yard plans are verified. The children will have access to the living room, the family room, kitchen area and the bathrooms off the kitchen and hallway. The "off limits" areas include the garage, the hallway bedrooms one and master bedroom. These areas were made inaccessible by door knob slip covers. The home is clean and orderly at this time and will remain so during child care hours. The licensee cell phone will be the primary phone for the facility. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. The applicant stated that there are firearms. The firearms and ammunition are locked in a manner which meets regulations. There are no poisons stored on the premises, however LPA and applicant discussed the regulation that poisons are to be locked using a key or combination lock was reviewed. First Aid supplies will be maintained at the facility. The children in care will have access to age appropriate toys and equipment. The home is equipped with a working smoke detector, carbon monoxide detector and has a fire extinguisher rated at 2A40BC. The home's main backyard is fully fenced but will not be used for outdoor child care as there is a pool in the backyard. The fencing and gate system meets regulatory requirements. There side yard is accessed from the front door. This area will be used as the outdoor play area. The outdoor side yard is not fully fenced. The regulation for outdoor supervision was reviewed with the applicant.
An approved fire inspection was received by the department on 3/19/2021. The applicant is qualified based on her kindergarten teaching experience in St. Helena and Calistoga.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2021
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: BOHAN, NAHANI FCCH
FACILITY NUMBER: 173010033
VISIT DATE: 05/21/2021
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Incidental Medical Services (IMS) regulations were reviewed with the applicant. The applicant understands that if Incidental Medical Services are provided, an updated Plan of Operation shall be submitted and on file with the Department.

The safe sleep regulations were reviewed and discussed with the applicant.

Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. Parent's rights poster will be posted. Emergency drills must be conducted at least once every six months and the date documented. Children's records to be maintained were reviewed. The roster is to remain current at all times. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days. The licensee will maintain current pediatric CPR and First Aid certification. The licensee shall be present in the home and shall ensure that children in care are supervised by an adult with current pediatric CPR and First Aid certification and criminal record clearance. The applicant understands that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. Infants and children shall not be allowed to sleep in car carriers in the home. The applicant clearly understands the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school aged. Smoking is prohibited at all times in any area where child care is provided. The licensee understands the responsibility to read and have knowledge of the laws and regulations for operation of a family child care home. Forms and regulations must be obtained from the website. http://ccld.ca.gov/. The licensee has been signed up for PIN (provider information notices) for updates related to the child care program. Megan's Law web site was provided(http://www.meganslaw.ca.gov). The new infant safe sleep regulations, the AAP Guide to Safe Sleep Practices and the Effects of Lead Exposure brochures were provided and reviewed with the applicant. The applicant understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice.
Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

The licensee is awaiting her TB test results for her spouse and immunization Titers test results before being approved for licensure.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: BOHAN, NAHANI FCCH
FACILITY NUMBER: 173010033
VISIT DATE: 05/21/2021
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LPA Ouye and the applicant also discussed and covered the COVID-19 guidelines and reviewed the facility's screening procedure which includes social distancing, facial covering, posing COVID-19 assessment questions, conducting visual well-ness checks, temperature screening, parents bring their own pens; and hand washing for a minimum of 20 seconds. Various COVID-19 related handouts were posted, and the applicant designated the kitchen as the Isolation Area. The applicant confirmed the understanding of the COVID-19 guidelines and remains committed to following COVID-19 guidelines.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021
LIC809 (FAS) - (06/04)
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