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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376616187
Report Date: 05/17/2021
Date Signed: 05/17/2021 02:15:55 PM

Document Has Been Signed on 05/17/2021 02:15 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ALEXANDER, MICHELLE A. FAMILY CHILD CAREFACILITY NUMBER:
376616187
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
05/17/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:43 AM
MET WITH:Michelle AlexanderTIME COMPLETED:
02:30 PM
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On 05/17/2021 at 9:43 am, Licensing Program Analyst (LPA) Julissa Valle made an unannounced tele-inspection for the purpose of an increase in capacity with licensee, Michelle Alexander. During the inspection there were 6 children present.

On 05/12/2021, a fire clearance was approved for 14 children. Licensee uses the following areas for child care: entire family room area, bathroom #2, and side yard connected to family room area. The off limits are all made inaccessible via gates and door locks. There are no bodies of water observed during time of inspection. There is a sufficient amount of age appropriate toys and play equipment available. The home was clean and orderly, with comfortable temperature and ventilation for safety and comfort during the inspection. The fire extinguisher is rated 3-A;40; BC and, smoke alarm and carbon monoxide detector are operational. There is a working telephone in the home and all required forms are posted. Licensee stated that there are no firearms or ammunition on the property. All adults living or working in the home have been fingerprint cleared and associated. LPA reviewed children's files, child care roster, and emergency drill log. Licensee texted a copy of the child care roster. Last fire/disaster drill was conducted 04/01/2021. Pediatric CPR and First Aid certification expires on 08/2022. Mandated Reporter training certification expires on 04/26/2023. LPA discussed with Licensee maintaining supervision of day care children at all times. LPA reviewed the following with licensee: SIDS, car seat law, reporting requirements, shaken baby syndrome, lead exposure, safe sleep and care and supervision. Licensee was also reminded the following items are prohibited during day care operating hours (walkers, exersaucers, jumpers and bouncy seats). Corporal punishment and smoking are not allowed in the day care.



Licensees stated she does not provide Incidental Medical Services (IMS) at this time. 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.html
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Julissa Valle
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2021
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ALEXANDER, MICHELLE A. FAMILY CHILD CARE
FACILITY NUMBER: 376616187
VISIT DATE: 05/17/2021
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The maximum capacity for a large family child care home: 12 children (with a qualified assistant) with no more than 4 infants; or (with landlord consent) 14 children (with a qualified assistant) with no more than 3 infants, 1 child enrolled in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home. When there is no Qualified Assistant, 14 years of age or present, the capacity reverts back to the requirements for a Small Family Child Care. To access our Regulations and Forms please use our WEBSITE: http://ccld.ca.gov.

Upon a final file review a Regular Large Family Child Care Home license may be issued for 14 children. LPA Julissa Valle, explained inspection report to applicant, applicant stated she understood

An exit interview was conducted. A copy of this Facility Evaluation Report (LIC 809), Licensee/Appeal Rights (LIC 9058) and Notice of Site Visit form is required to be posted for 30 days (LIC 9213). All forms will be e-mailed to the Applicant. The Applicant was advised that acknowledgement of the receipt of the report is to be received within twenty-four hours.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Julissa Valle
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021
LIC809 (FAS) - (06/04)
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