343623706-4-23-2021-03-CC-ABLI-C2CTYZ-20210423150935

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623706
Report Date: 04/23/2021
Date Signed: 04/23/2021 03:10:25 PM

Document Has Been Signed on 04/23/2021 03:10 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	JENKINS, JALIZA		FACILITY NUMBER:	343623706
ADMINISTRATOR:	JENKINS, JALIZA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 913-1948
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	04/23/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Jaliza Jenkins		TIME COMPLETED:	03:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 4/23/21 at approximately 2:30pm, Licensing Program Analyst (LPA) Amanda Blesi met with licensee Jaliza Jenkins for an announced change of location tele inspection via Facetime video call due to the COVID-19 pandemic. Licensee was previously licensed under facility #343622914 as a large license and has now requested to reduce her capacity from a large to a small license. Licensee and one minor child live in the home. Licensee understands that anyone living or working in the home, eighteen years of age or older must obtain fingerprint clearance PRIOR to living or working in the home. A health and safety video inspection was conducted inside and out via Facetime while licensee held the phone and toured the home. The one story home has 3 bedrooms, 2 bathrooms, a living room, dining room kitchen, and laundry room (no garage). There are two rooms designated for child care use only. Off limit rooms consist of all three bedrooms, one bathroom, and laundry room. The backyard is fenced and contains a locked shed. There are no bodies of water observed on the property. Licensee understands that 100% supervision is required in unfenced areas. Toxic and hazardous items are inaccessible to children. Functioning smoke and carbon monoxide detectors and a fire extinguisher were observed in the home. Pediatric CPR and first aid training including the one hour Lead Poisoning Prevention was verified and expires on 4/8/2023. Licensee stated there are no weapons in the home. LPA discussed the Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care Home must have vaccinations against, Pertussis, Measles and Influenza. Proof of required vaccines have been obtained from Licensee. *Report continued on 809-C..*

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2021

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: JENKINS, JALIZA	FACILITY NUMBER: 343623706
	VISIT DATE: 04/23/2021

NARRATIVE

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Licensee has completed the required AB1207 Mandated Reporter training that will expire 2/2022. Licensee understands that the training must be completed once every two years. Licensee understands that a current children's roster must be maintained and that a fire drill must be conducted and documented once every six months.

Licensee understands that if any structural changes are made to the home; licensing must be notified prior to construction. Licensee understands that if she wants to make any off-limit areas an ON-limits for children, she must notify licensing and LPA must do an inspection BEFORE children are allowed in the areas.

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.

Safe sleep regulations were discussed with Licensee.
LPA observed Covid-19 posters posted as required and Covid-19 guidelines were reviewed and discussed.

LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the applicant can request to be added to the distribution list to receive Quarterly Updates. LPA provided the Licensing Agency website (WWW.CCLD.CA.GOV), so that licensee may obtain updated licensing information, regulations, PINs, and forms.

Effective today April 23, 2021, the facility is approved for a change of location and to reduce the capacity from a large to a small license. The new licensee is approved for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.

This report was reviewed and discussed with licensee. In lieu of the Licensee's signature, LPA is emailing the report. Once received, licensee shall respond that she has read and understands the report.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2021

LIC809 (FAS) - (06/04)

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