010208145-5-26-2023-02-CC-ILOA-CS7NDS-20230526102249

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010208145
Report Date: 04/27/2022
Date Signed: 05/26/2023 10:22:55 AM

Document Has Been Signed on 05/26/2023 10:22 AM - 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:	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: 3	DATE:	04/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Mary and Earl Nubin		TIME COMPLETED:	11:45 AM

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 4/27/2022 at 8:25am, Licensing Program Analysts (LPAs) Indira Loza and Catherine Fernandes met with Licensees Earl and Mary Nubin for an Unannounced Required Annual Inspection. Present during the inspection were the Licensees and three preschool children in care. Licensee’s home was toured for a health and safety inspection. The facility operates from 7:30am – 6:30pm Monday thru Friday. The home is a two bedroom two bathroom, the house 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(in the back of the house), bedrooms, rear bathroom, and backyard. The off limit areas are the detached garage and the front bathroom made inaccessible by closed and/or locked doors and visual supervision. The bedroom will used as the isolation area. The backyard is fenced in, with toys that were observed today as safe, clean and good repair. LPAs observed an ample supply of toys and activities, which appear to be age appropriate and in good condition. LPAs 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, and working telephone. The heaters and fireplace were screened off to prevent access by children. The licensee stated that there are no firearms in the home. The Licensees CPR certificate expired March 14,2022. They have scheduled an appointment for CPR/First Aid certification. All the children's files were reviewed. All required forms are posted and visible for public view. LPAs obtained the facility roster. LPA observed a current fire and disaster drill log with the last drill conducted on 4/27/22. 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, *************809 Continued*****************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

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: NUBIN, MARY & EARL	FACILITY NUMBER: 010208145
	VISIT DATE: 04/27/2022

NARRATIVE

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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 will complete the mandated reporter training.

There are no deficiencies being cited today.
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 with the Licensees.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

LIC809 (FAS) - (06/04)

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