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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009838
Report Date: 03/30/2022
Date Signed: 03/30/2022 12:47:03 PM

Document Has Been Signed on 03/30/2022 12:47 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:MCQUEEN, JACOYA FCCHFACILITY NUMBER:
483009838
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
03/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Jacoya McQueenTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Glenn Ouye arrived to conduct a capacity increase. The licensee is going from a small to a large family child care home. The application was received on March 15, 2022.

The facility has a fully charged fire extinguisher rated at least at 2A10BC. The carbon monoxide and smoke detectors were tested and functional. The licensee conducts emergency disaster drills every six months and the drills are documented and posted near her license.

The child capacity and ratio postings were provided and discussed with the licensee.

Based on this inspection the facility is approved for licensure effective March 30, 2022.

No deficiencies cited during the visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2022
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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