010206795-6-13-2022-02-CC-CFES-CFCRMP-20220613130904

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010206795
Report Date: 06/13/2022
Date Signed: 06/13/2022 01:09:23 PM

Document Has Been Signed on 06/13/2022 01:09 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:	SPATHIS, EVANGELIA		FACILITY NUMBER:	010206795
ADMINISTRATOR:	SPATHIS, EVANGELIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 531-9281
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94619
CAPACITY:	12	CENSUS: 8	DATE:	06/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Evangelia Spathis		TIME COMPLETED:	01:20 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	On 06/13/2021 at 9:05am Licensing Program Analyst (LPA) Catherine Fernandes met with Licensee Evangelia Spathis for an Unannounced Required Annual Inspection. Present during the inspection was the Licensee, her finger print cleared husband, four infants and four preschoolers in care. The home was toured for a health and safety inspection. The facility operates from 7:30am – 5:30pm Monday – Friday. The home is a two story house that consists of three bedrooms and two in half bathrooms. The entrance to the day care is down two sets of stairs and through the back yard. The inside of the home was observed to be neat and clean with age appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible to the child in care. ON LIMITS AREA: Are the entire downstairs area of the home, which includes the main area, the half bathroom, the laundry room, and both areas of the fenced in backyard. OFF LIMITS AREA: are the entire upstairs of the home ISOLATION AREA: Is the futon next to the laundry room. The backyard has a wooden structure that is observed secured during today's inspection. LPA observed four pack and plays for the infants in care. The home has a fully charged 3A40BC fire extinguisher on top of the downstairs refrigerator, a working smoke detector in the main room and a functioning carbon monoxide detector. The Licensee has provided a working telephone number and email address. The licensee's CPR and First Aid certificate is current and expires on 02/23. Per Licensee, there are no firearms in the home. LPA Fernandes reviewed staff and eight children's files. LPA obtained a copy of the facility roster. Report continues on 809C.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022

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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Document Has Been Signed on 06/13/2022 01:09 PM - It Cannot Be Edited

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: SPATHIS, EVANGELIA	FACILITY NUMBER: 010206795
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above there are no current disaster drills, which poses a potential safety risk to persons in care.
	POC Due Date: 07/13/2022
	Plan of Correction
1 2 3 4	The Licensee will conduct a disaster drill and document the drill then send a copy to CCL by POC date.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above the licensee's assistant has not completed mandated reporter training which poses potential safety risk to persons in care.
	POC Due Date: 07/13/2022
	Plan of Correction
1 2 3 4	The assistant must complete the full training and submit proof to CCL by POC date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/13/2022 01:09 PM - It Cannot Be Edited

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: SPATHIS, EVANGELIA	FACILITY NUMBER: 010206795
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above the assistant does not have proof of immunization which poses a potential health risk to persons in care.
	POC Due Date: 07/13/2022
	Plan of Correction
1 2 3 4	The licensee will provide proof of immunization and then send it to CCL by POC date.

Type B

Section Cited

CCR

102416.1(a)(6)

Personnel Records

(a) Personnel records shall be maintained on each employee and shall contain the following information: (6) Documentation of completion of training on preventative health practices as required by Section 102416(c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above the is no proof of preventative health classes, which poses potential health aand safety risk to persons in care.
	POC Due Date: 07/13/2022
	Plan of Correction
1 2 3 4	The licensee will come preventative health training and orientation training and submit proof to CCL by POC date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022

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: SPATHIS, EVANGELIA	FACILITY NUMBER: 010206795
	VISIT DATE: 06/13/2022

NARRATIVE

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The following was observed during the inspection
- There was no fire drill log available for review, Licensee stated the last drill was done about 8-12 months ago.
- During file reviews LPA observed licensee's husband/assistant is missing Mandated reporter training, proof of immunization and TB test.
- Licensee is missing preventative health training and orientation training.

Incidental Medical Services (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.htm
Licensee is providing IMS at this time and needs to submit the written plan for providing IMS to the department.

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 $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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.

Report continues on 809C.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022

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: SPATHIS, EVANGELIA	FACILITY NUMBER: 010206795
	VISIT DATE: 06/13/2022

NARRATIVE

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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/process.

The following copies are needed for the facility file and need to be turned by 6/13/22:
- LIC610A Updated Emergency disaster plan
- LIC999A Facility sketch

See 809D for deficiencies that were cited during today's inspections.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted
Report and Appeal Right were provided

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022

LIC809 (FAS) - (06/04)

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