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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010211636
Report Date: 02/21/2020
Date Signed: 02/21/2020 02:15:33 PM

COMPREHENSIVE INSPECTION
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:SHEFFIELD, MARY J.FACILITY NUMBER:
010211636
ADMINISTRATOR:SHEFFIELD, MARY J.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 849-9352
CITY:BERKELEYSTATE: CAZIP CODE:
94705
CAPACITY:14CENSUS: 10DATE:
02/21/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Licensee Mary SheffieldTIME COMPLETED:
03:45 PM
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On 02/21/2020 Licensing Program Analyst (LPA) Brittany Newton made an unannounced required inspection at the above facility. LPA was met by licensees assistant L. Mascuch and C. Melendez. Mary later joined the visit. Present for the inspection was 10 preschoolers. The home was toured to conduct a health and safety inspection. The licensee operates the day care living room/dining room and backyard area. The bedroom and office upstairs are off-limits. The home provides snacks and is apart of the food program. The home has one bathroom inside and one child size bathroom with two sinks and two toilets in the backyard. Both bathrooms were inspected and found in compliance. The two stairwells have secure barricades on them. There are ample toys and equipment for children in care. Fenced backyard area was found free of hazards. There is a large play structure, sand box, and other toys available for the children. There is a fireplace in the living room that is decorative only. Electrical outlets are covered for safety of children. There is a fully charged 2A10BC fire extinguisher and working smoke alarm and carbon monoxide detector. CPR and First Aid is current until 10/2021. Fire drills have been being conducted with the last one being 12/09/19. All required forms are posted. LPA reviewed children files which were found in compliance.
Individual Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. Currently, the licensee has no kids in care requiring medicine. 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 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. Licensee was reminded of the responsibility as a mandated reporter and the requirement to complete the training every 2 years.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Brittany NewtonTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
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: SHEFFIELD, MARY J.
FACILITY NUMBER: 010211636
VISIT DATE: 02/21/2020
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A child care roster was obtained.

No deficiencies observed at this visit. A Notice of Site visit was given and facility was reminded that it is required to be posted for 30 days. Exit interview conducted, appeal rights provided, and a copy of this report was left with licensee Mary Sheffield.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Brittany NewtonTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
LIC809 (FAS) - (06/04)
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