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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500599
Report Date: 12/13/2023
Date Signed: 12/13/2023 01:33:20 PM

Document Has Been Signed on 12/13/2023 01:33 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KEMOKAI, RASHIDIFACILITY NUMBER:
344500599
ADMINISTRATOR:KEMOKAI, RASHIDIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 513-9610
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
12/13/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Rashidi KemokaiTIME COMPLETED:
02:30 PM
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On 12/13/2023, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the Family Childcare Home (FCCH) for the purpose of a Plan of Correction inspection. LPA arrived at the FCCH and was met by Licensee Rashidi Kemokai (L1). LPA disclosed the purpose of the inspection and was granted entrance into the FCCH. LPA observed 2 infants and a preschool aged child being supervised by L1 and an adult Aide. Also present in the FCCH was L1's spouse. LPA determined, through accessing Guardian, that all required adults were background cleared and associated to the license.

During an Annual Random Inspection conducted on 11/02/2023, L1 was issued 3 deficiencies for not having children's files with required forms and immunizations, not having completed adult's files with required forms and immunizations, and not having 2 stairways barricaded to prevent access from children in care. The plan of correction due date was agreed upon for 12/04/2023. During today's inspection on 12/13/2023, LPA reviewed both children's and adult's files which contained required forms and immunizations. LPA also inspected the stairways and observed both stairways to be barricaded by installed baby-gates LPA cleared the deficiencies from 11/02/2023 and provided L1 with a letter of clearance.

An exit interview was conducted, and the report was reviewed with L1. LPA provided L1 with Licensee Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023
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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