010206421-3-24-2022-02-CC-PDYR-CCTQBR-20220324120159

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010206421
Report Date: 03/24/2022
Date Signed: 03/24/2022 02:17:50 PM

Document Has Been Signed on 03/24/2022 02:17 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	WILSON, ALICE MAMIE		FACILITY NUMBER:	010206421
ADMINISTRATOR:	WILSON, ALICE MAMIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 639-7353
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94603
CAPACITY:	14	CENSUS: 0	DATE:	03/24/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Alice Wilson		TIME COMPLETED:	12:15 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	An unannounced Required - 1 Year inspection was conducted by Licensing Program Analyst L. Dyer. LPA arrived at the facility at 9:00 a.m. The licensee was present. There are no children present on the date of this inspection. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall obtain a California clearance or criminal record exemption prior to working, residing or volunteering in a licensed facility. Phone number and e-mail address are current. Hours: 8:30 a.m. - 6:00 p.m. The day care area of the home was inspected. Areas licensed for child care: living room, day care room, bathroom, kitchen, dining room. Off-limit areas will be made inaccessible to children by closed and/or locked doors; gates; and visual supervision. At 9:30 a.m., the following was observed: The home was clean and orderly, with adequate heating and ventilation. There were safe, healthful and comfortable accommodations, furnishings and equipment available to children at the time of this inspection. There were a variety of books and toys for children's use. There was a working smoke detector (tested); a fully charged 2-A:10-B:C fire extinguisher; a first aid kit, and a carbon monoxide detector. Fireplace is closed off. There are no hazardous materials, medicines, or cleaning solutions accessible to children during this inspection. Hazardous items are kept in the pantry, inaccessible to children. There are no bodies of water or firearms in the home. LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licening/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. Also given and discussed: Guidance for Child Care Providers and Programs (version June 29, 2021) and Individual Sleeping Plans. (continued)

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: WILSON, ALICE MAMIE	FACILITY NUMBER: 010206421
	VISIT DATE: 03/24/2022

NARRATIVE

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The handout, "A Child Care Provider's Guide to Safe Sleep" was provided and discussed, along with the requirements for an Individual Infant Sleep Plans. There are no infants enrolled at the facility at the present time. Discussed with the licensee: Individual Sleeping Plans, pacifiers, cots, sheets and bedding.

Back yard area is securely fenced. Licensee has a slide, balls and other outdoor toys for child play. There is a swing set, trucks, a playhouse, balls, bowling, horseshoes, riding toys and chalk for outdoor play.

All required forms are posted and visible for public review. Roster will be updated and fire drill will be completed when children are enrolled at the facility. LPA reviewed facility, children's (none enrolled) and personnel records at 11:11 a.m.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500 maximum per day/per person will be assessed if this regulation is violated. Licensee was also reminded of the Department's Inspection authority, and the need to comply when notified that termination of an employee is necessary. Also discussed with the licensee: supervision of children at all times; swaddling; children are not to be left in parked vehicles; car seats and high chairs; Unusual Incident Reporting; advertisements; changes in on-limit areas; construction work at facility; paying fees on-line; smoking; ill children in home (if children become ill they are to be separated immediately from the other children), and the new Guardian background check process.

A qualified assistant must be physically present whenever 9 or more children are in care. When an assistant is not present, the home reverts back to small family child care ratios.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.
(continued)

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: WILSON, ALICE MAMIE	FACILITY NUMBER: 010206421
	VISIT DATE: 03/24/2022

NARRATIVE

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Important E-mail Addresses:
Community Care Licensing General Information and Updates:www.ccld.ca.gov. For updates, click the "Receive Important Updates" box.
Mandated Reporter Training: www.mandatedreporterca.com (Child Care Providers Module - required every 2 years).
Alameda County Public Health Department Website: www.acphd.org
Guardian: background check process with self-service options: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

NO DEFICIENCIES CITED TODAY.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Alice Wilson.

Exit interview conducted with Licensee Alice Wilson, where this report was discussed, and signatures obtained acknowledging receipt of documents. A Notice of Site Visit was issued and must be posted on or adjacent to the interior side of the main door into the facility for 30 consecutive days.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC809 (FAS) - (06/04)

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