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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010210818
Report Date: 06/17/2022
Date Signed: 06/17/2022 01:40:52 PM


Document Has Been Signed on 06/17/2022 01:40 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:NELSON, BARI LYNNEFACILITY NUMBER:
010210818
ADMINISTRATOR:NELSON, BARI LYNNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 526-8747
CITY:BERKELEYSTATE: CAZIP CODE:
94708
CAPACITY:12CENSUS: 7DATE:
06/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:56 AM
MET WITH:Bari Lynne NelsonTIME COMPLETED:
01:45 PM
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On June 17, 2022, Licensing Program Analyst (LPA), Indira Loza, met with licensee Bari Nelson for an UNANNOUNCED RANDOM INSPECTION. Present for this inspection were licensee, finger print cleared assistant, Alison, and 7 preschool-aged children. The home was toured to conduct a Health and Safety Inspection. The facility's operating hours are from Monday through Friday 8:30 AM to 1:30 PM.

The home is a two story single family house which is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the living room with deck (main day care area), kitchen, hallway bathroom, bedroom next to the hallway bathroom (playroom), and backyard . The OFF LIMIT AREAS are bedroom across from the front door and downstairs bedroom and bathroom. The stairs leading downstairs is only used to access the outdoor play area. Other than that, the stairs are barricaded to prevent access by children. The ISOLATION AREA will be in the play room. The outdoor play area is free from defects or dangerous conditions and is completely fenced. The deck area is open to the children and is properly fenced. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children.
The Licensee’s Pediatric CPR and First Aid training has been completed and expires May 2024. LPA obtained the children’s files for review and the children's roster.

Licensee was reminded that California Law requires Licensee to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone or fax. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com.
********************************Report continues on 809-C*****************************
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2022
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: NELSON, BARI LYNNE
FACILITY NUMBER: 010210818
VISIT DATE: 06/17/2022
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  • Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. The Licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Licensee was advised to sign up for Provider Information Notices (PINs) at https://www.cdss.ca.gov/inforesources/community-care-licensing/policy/provider-information-notices/child-care
  • Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02 CCP. 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.
  • 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.
  • 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 webpage athttps://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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Bari Nelson
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
LIC809 (FAS) - (06/04)
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