010208145-8-15-2019-02-CC-LDYN-BF3S76-20190815133701

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010208145
Report Date: 08/15/2019
Date Signed: 08/15/2019 01:37:08 PM

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:	NUBIN, MARY & EARL		FACILITY NUMBER:	010208145
ADMINISTRATOR:	NUBIN, MARY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 534-5483
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94619
CAPACITY:	12	CENSUS: 7	DATE:	08/15/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:53 PM
MET WITH:	Earl Nubin		TIME COMPLETED:	01:55 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 8/15/19 at 12:53pm, Licensing Program Analyst (LPA) Loretta Dyson arrived at the home for an unannounced random inspection. LPA met with the licensees. There were 7 children present. LPA conducted an inspection of the areas of the home that are used for child care. The home is clean and has heating and ventilation for the safety and comfort of children in care. The on limit areas are the kitchen, living room, dining room, family/child care room, bedroom, rear bathroom, and backyard. The off limit areas are made inaccessible by closed and/or locked doors and visual supervision. The bedroom is used as the isolation area, away from other children in care. The fenced backyard is used for outdoor play, and LPA observed that it is free from defects or dangerous conditions. LPA observed an ample supply of toys and activities, which appear to be age appropriate and in good condition. LPA did not observe any bodies of water, hazardous items or toxins accessible today. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, carbon monoxide detector, telephone, and fully stocked first aid kit. The heaters and fireplace are screened to prevent access by children. The licensee stated that there are no firearms in the home. There is current liability insurance. The home is in ratio today. The licensees have current CPR/first aid certificates. Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to sign up to receive quarterly updates by email by sending a request to ChildCareAdvocatesProgram@dss.ca.gov. The Licensee was given a copy of A Child Care Provider's Guide to Safe Sleep pamphlet and LPA discussed safe sleep practices and policy.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019

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: NUBIN, MARY & EARL	FACILITY NUMBER: 010208145
	VISIT DATE: 08/15/2019

NARRATIVE

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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. The licensees stated that there are no children in care that require medication while in care.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. LPA reviewed the individuals associated to the license, and the licensee confirmed that everyone who is required to have a criminal record clearance is associated. Licensee was reminded of the responsibility as a mandated reporter. The licensees have completed the mandated reporter training.

There are no deficiencies being cited today. This report shall remain on file for 3 years. A Notice of Site visit was given to Licensee, and Licensee was reminded that it is required to be posted for 30 days. An exit interview was conducted.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019

LIC809 (FAS) - (06/04)

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