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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010211221
Report Date: 03/05/2020
Date Signed: 03/05/2020 01:41:19 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:MILES, MARY & TARVER, MITCHELLFACILITY NUMBER:
010211221
ADMINISTRATOR:MILES, MARYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 299-1401
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY:14CENSUS: 10DATE:
03/05/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Mitchell MilesTIME COMPLETED:
01:50 PM
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On 03/05/2020 at 11:40 AM Licensing Program Analysts (LPAs) Arminder Singh and Monica Mathur conducted an unannounced Annual/Random Inspection at Mitchell Tarver's and Mary Mile's Family Day Care Home. LPAs met with Licensee, Mitchell Tarver and explained the purpose of today’s inspection. Present in the home were Licensee, two fingerprint cleared assistants, and ten (10) children (2 infants, 8 preschoolers).. Facility is in compliance with required ratios/capacity today. Children were engaged in various activities under the supervision of the Licensee and Assistants. Days and hours of operation are Monday - Friday from 8:00 AM - 5:00 PM. Both Licensees reside in the home.
At 12:00 PM LPAs toured the indoor and outdoor areas of the home during today's inspection. The Home is a two story that consists of a living room, dinning room, kitchen, 3 bedrooms, 1 upstairs bathroom, the downstairs area includes the children's quiet room, a kitchen with dinning area, bathroom, laundry room, back room, fenced front yard and a fenced backyard.
INDOOR SPACE: In Use Areas: The entire lower level of home is on limits which includes cubby room, garage (playroom), activity room/red-room, kitchen, bathroom, and the backyard
Off Limit Areas: The entire upstairs area and fenced front yard are the off limit areas.
The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children in the home. Furniture and equipment, such as mats and tables were age appropriate and in good condition. There were no baby walkers or bouncers observed on the premise during today’s inspection. The home is orderly, and safe for the day care children. LPA's did not observe any wall heaters in the home.
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SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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: MILES, MARY & TARVER, MITCHELL
FACILITY NUMBER: 010211221
VISIT DATE: 03/05/2020
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OUTDOOR SPACE: In Use Areas: The backyard is on limits. The outdoor space and play equipment were observed to be maintained in safe condition and free of hazards. The yard was fenced and there were no bodies of water. The side of the yards are properly barricaded and gated and made inaccessible to children. The play yard has a padded surface.
LPA's observed a fully charged 3A40BC fire extinguisher in the kitchen. Facility has working smoke / carbon monoxide detectors. The Licensee states that there are no weapons in the home. Licensee does have two pet dogs in the home. Last fire/disaster drill was completed on 03/02/20. All required postings including but not limited to Parent Rights Poster, Facility License, Emergency Disaster Plan were observed posted on a wall in the Day care Playroom area. The Licensee states that he does not transport children. Licensee states that they supply snacks only. Food storage area was observed to be sanitary and safe. Day care home appeared to be free of flies, other insects, and rodents during today’s inspection.

FILE REVIEW:
At 12:30 PM five (5) Children's files were reviewed and contained all required Licensing forms and records including but not limited to Receipt for Parents' Rights, Immunization record, Identification & Emergency Information, Health History. Two(2) staff file was reviewed and contained all required Licensing forms. LPA's reminded licensee that mandatary reporter training is valid for two years and must be renewed. All staff member and Licensee's mandated reporter training expired on 02/2020. Pediatric CPR/First Aid Certificates were current for staff members and Co-Licensee. Co-Licensee, Mary Miles does not have current certificate on file.

Supervision of children was discussed with the Licensee and he understands that he must be present in the home during 80% of the operating hours of the day care and ensure that the children are supervised at all times. The Licensee understands the capacity options and that she cannot have more than 8 children in the home at any time without at least two qualified adults present. Licensee also understands that she must comply with the ratio and capacity requirements of the Small Family Child Care Home license whenever she or a qualified adult is alone with the children.
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SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
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: MILES, MARY & TARVER, MITCHELL
FACILITY NUMBER: 010211221
VISIT DATE: 03/05/2020
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LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who comes in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12-month period.

LPA advised the Licensee of the required Mandated Reporter Training for Child Care Providers that all Licensees and employees are required to complete as of January 1, 2018. The website for the online training is: http://www.mandatedreporterca.com/training/childcare.htm.

Individual Medical Services (IMS) policy was discussed. The Licensee stated that she currently does not have any one child in care who requires IMS. 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

Beginning January 1, 2019 AB 2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” and “Safe Sleep Information Flyer” to Licensee.



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ccld.ca.gov or email: childcareadvocates@dss.ca.gov

Deficiency was cited during today’s visit. See LIC809-D Page

At 1:30PM an exit interview was conducted with the licensee/director. The licensee was provided a copy of her/his appeal rights and the signature on this form acknowledges receipt of these rights. A Notice of Site visit was posted at the time of inspection and must remain posted for 30 days.
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: MILES, MARY & TARVER, MITCHELL
FACILITY NUMBER: 010211221
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/06/2020
Section Cited

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102416 Personnel Requirements(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid[...] This requirement was not met as evidenced by:
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Per LPA's review of files Co- Licensee, Mary Miles does not have current Pediatric CPR/First aid training. This poses a potential risk to the health and safety of children in care.
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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: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2020
LIC809 (FAS) - (06/04)
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