010214276-11-5-2021-52-CC-RHAR-C8GSVP-20211105141305

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010214276
Report Date: 11/05/2021
Date Signed: 11/05/2021 02:13:21 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	BARRERA, LILLIAN		FACILITY NUMBER:	010214276
ADMINISTRATOR:	BARRERA, LILLIAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 648-5830
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY:	12	CENSUS: 4	DATE:	11/05/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:02 PM
MET WITH:	Lillian Berrera		TIME COMPLETED:	02:20 PM

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On November 5, 2021 at approximately 12:02pm Licensing Program Analyst (LPA) Russ Haderer arrived and met with licensee Lillian Berrera for the purpose of conducting an unannounced annual inspection for health and safety. Living in the home is the licensee, her TB test and fingerprint cleared husband and two children. Present for today’s inspection was licensee and 4 children in care (two 3 years-old and two 4 years-old). The facility is in ratio today. The hours of operation are Monday-Friday, 5:00am to 5:00pm.

The facility is a single story home with a front and back yard area and an attached 2-car garage. There is no fireplace in the home.

ISOLATION AREA will be in the living room area away from other children in care. The child can be watched and taken care of in that area until their parent arrives.

On-limit-areas include: Living room, dining room, kitchen, main house bathroom and backyard patio area (surrounded by child fencing).

Off-limit-areas include: All 4 bedrooms of the home, attached 2-car garage, western side of the back yard area (fence is in place to keep the children from entering), side yards, and front yard. All off limit areas are inaccessible by closed and/or locked doors and visual supervision.

There were ample age appropriate toys that were observed to be safe and in good condition. The home is neat and clean, with heating and ventilation for safety and comfort. LPA did not observe any hazardous materials, or toxins accessible to children on the premises during the inspection.

There is a fully charged 3A40BC fire extinguisher located in the entry hallway. The facility has a working smoke and carbon monoxide detectors. Per licensee, there are no firearms in the home. The licensee conducts and documents Fire/Disaster Drills monthly, and the log indicates a drill was conducted 11/1/2021. All required licensing documents are posted and visible for public review.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: BARRERA, LILLIAN	FACILITY NUMBER: 010214276
	VISIT DATE: 11/05/2021

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At 1:30pm children's files were reviewed and found to be complete. The facility roster was reviewed, and a copy obtained. All files were complete.

The licensee’s Pediatric CPR/First Aid certificate is current and expires 6/20/2023. Mandated reporter training completed 4/19/2021. Licensee, and all adults living in the home are in compliance with immunization law which pertains to day care providers,

LPA reminded the licensee of the following: Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

The licensee owns the property and does not carry liability insurance, parental signed forms in the children’s files acknowledging this.

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

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.

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/inspection-process.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: BARRERA, LILLIAN	FACILITY NUMBER: 010214276
	VISIT DATE: 11/05/2021

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LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] 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.

There were no deficiencies issued during today’s inspection: This report will remain on file for 3 years.

A review of operating safely during the Covid-19 pandemic (RAST) was conducted.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Lillian Berrera.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021

LIC809 (FAS) - (06/04)

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