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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005377
Report Date: 06/03/2021
Date Signed: 06/07/2021 10:15:43 AM

Document Has Been Signed on 06/07/2021 10:15 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:COHEN, REJANYFACILITY NUMBER:
214005377
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
06/03/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Rejany CohenTIME COMPLETED:
01:40 PM
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On 6/3/21 at 12:30 pm., Licensing Program Analyst (LPA), Farhan Bashir-Tariq conducted a scheduled case management inspection for capacity increase and met with Licensee, Rejany Cohen. This inspection was conducted via Face Time due to COVID-19 restrictions. Purpose of inspection was explained. LPA verified the background check clearance of adults working or living in the home. This is a three bedroom and two-and-a-half-bathroom house. Hours of operation will be: M-F, 7:30 am- 5:30 pm. Licensee provides breakfast, lunch and three snacks. Licensee is not part of food program at this point. Daycare areas: Living room /Play room, Bathroom(half) #3, Patio, TV room, Back yard, Bedroom #1, Bedroom #2 and Bedroom #3. All three bedrooms will be used for napping only. OFF limit areas: Bathroom #1, Bathroom #2 and Garage

LPA and Licensee virtually inspected the entire home for health and safety hazards. All off limit areas were properly barricaded and made inaccessible to children in care. License and all other required licensing documents will be posted in the play room. Living room/Play room will be used as main child care area. Per Licensee, all electric outlets in living room and bedrooms had safety covers on them. Windows in living room and bedrooms had built in locks on them. Kitchen is off limit and has been blocked off with a baby gate at entrance. Chemicals will be stored in garage, which is off limits. All sharp and harmful objects were stored and made inaccessible from children in care. LPA observed that there were plenty of toys, books, arts, crafts and other learning materials available in the home. Home was observed to be clean and orderly with enough lighting and ventilation. Back door opens to a patio room and leads up to back yard. Both patio and back yard was approved to be used for children. Patio had furniture, toys and other age appropriate material for children. Back yard was fully fenced all around. LPA observed that there were a number of slides and play structures available in the back yard. Artificial grass was installed in all back yard and under slides to prevent any falls or injuries.

Following useful links were shared with Licensee:
Mandatory child abuse training for any new staff can be obtained at: www.mandatedreporterca.com.
For rules, regulation and PINS visit: www.ccld.ca.gov
Registration email for quarterly updates: childcareadvocatesprogram@dss.ca.gov.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2021
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: COHEN, REJANY
FACILITY NUMBER: 214005377
VISIT DATE: 06/03/2021
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LPA observed that there was a smoke and carbon monoxide detector available in the home. Licensee tested both detectors for this inspection. A working telephone and a fully charged fire extinguisher of size 2A10BC or bigger was available in the home. First Aid Kit was available and fully stocked. Licensee stated that are no firearms or weapons present in home. Per Licensee , there are no bodies of water/ swimming pools in the home. Per Licensee, she doesn’t have any pets. Licensee was reminded to conduct and log a fire and earthquake drill once every six months. Licensee conducted emergency drill in January 2021. Licensee has a current and valid First Aid and CPR card expiring in November 2021. Mandatory child abuse training was completed on 11/19/20. This training is valid for two years. Safe Sleep regulation were explained to Licensee. Licensees are now required to check on infants every fifteen minutes during nap times and log the time. Licensee was aware of the regulation and already documenting the times. A tele visit to provide technical assistance for issues related to COVID-19 was provided to Licensee on 8/21/20. LPA remined Licensee to continue the safety precautions. Licensee was reminded to clean and disinfect childcare areas thoroughly at least once a day. Posters containing information for COVID-19 symptoms, Social distancing, Face Coverings and Hand washing were observed to be posted in home and child care areas. Hand washing posters was observed to be posted in children’s bathroom.

LPA reminded Licensee that all adults, 18 years and older living in the home, helper, or assistant must have finger print clearance and must be associated to the facility by submitting an LIC 9182 with a copy of CDL or CA. ID prior to having any contact with children in care failure to do so could result in an immediate civil penalty. LPA reminded Licensee that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. This report was discussed and explained to Licensee. Records to be maintained in the facility were discussed and a copy of Form 311D was emailed to Licensee. Mandatory Posting Requirements: License, Emergency Disaster Plan, and Notification of Parent's Rights Poster. Capacity limits of a large family child care home was discussed. A handout explaining capacity and ratio limits was emailed to Licensee along with this report. Fire clearance for a large family child care home was granted by San Rafael Fire Department.

Large Family Child Care Home license is approved and will be effective as of today, 6/03/2021.

This report will be kept in the facility file and will be made available for public review upon request. Desk duty is available M-F, 8AM-5PM at (650) 266-8800. Website for forms and Regulations: www.cdss.ca.gov.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
LIC809 (FAS) - (06/04)
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