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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483008015
Report Date: 03/06/2025
Date Signed: 03/06/2025 12:35:01 PM

Document Has Been Signed on 03/06/2025 12:35 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:KING, NYISHA FCCHFACILITY NUMBER:
483008015
ADMINISTRATOR/
DIRECTOR:
KING, NYISHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 224-0893
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
03/06/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Nyisha KingTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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An annual/random inspection was made to the facility by Licensing Program Analyst (LPA), Cindy Castro. LPA met with Licensee (L1), Nyisha King. L1 was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

During the inspection the home was toured inside and outside. The licensee was supervising her grandson which is license exempt and operating within the licensed capacity and ratio requirements. Licensee reported that she is not currently caring or supervising any children that would require a license. The facility’s operating hours will be 8:00AM-5:30PM, Monday–Friday when the facility is opened. The floor plan submitted by the licensee was reviewed. L1 reported that she is the process of updating her floor plan before opening her FCCH and will submit an updated copy to the department. Children in care will have access to the living room, dining room, and one bathroom in the hallway. The "off limits" areas include all upstairs, kitchen, garage, laundry room and backyard observed to be made inaccessible by child safety gate and key locking mechanisms. There were no pools or other bodies of water observed in the yard. The home appears to be clean and orderly and was at a comfortable indoor temperature. There were safe toys and equipment available for children. There is a working telephone in the home. Items which could pose a danger to children (such as detergents, cleaning compounds, medications were observed to be stored out of the reach of children. Licensee stated that poisons in the home will be locked in upstairs room. LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. A fireplace is located in the dining/family room area and will be barricaded with a child safety gate. No children’s files were review as licensee stated that there are currently no children enrolled. L1 has not conducted an emergency drill within the past six months because there are no children enrolled. L1 stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection. L1's mandated reporter certification expires on 11/20/2025. L1 provided proof of registration for a CPR/First Aid training scheduled to be held on 03/11/25 and 03/12/25.

Continued on LIC 809-C

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Cindy Castro
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: KING, NYISHA FCCH
FACILITY NUMBER: 483008015
VISIT DATE: 03/06/2025
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LPA discussed and provide copy of the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 01/13/25.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

There were no Title 22 deficiencies cited during today's inspection.

A notice of site visit was given to licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Nyisha King

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Cindy Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
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