010216510-5-17-2023-02-CC-PDYR-CRWSCB-20230517134515

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010216510
Report Date: 05/17/2023
Date Signed: 05/17/2023 01:45:20 PM

Document Has Been Signed on 05/17/2023 01:45 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:	CARRIER-BROUSSARD, STACY		FACILITY NUMBER:	010216510
ADMINISTRATOR:	CARRIER-BROUSSARD, STACY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 632-2028
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94605
CAPACITY:	14	CENSUS: 1	DATE:	05/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Stacy Carrier-Broussard		TIME COMPLETED:	01:50 PM

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	An unannounced Required - 1 Year inspection was conducted by Licensing Program Analyst (LPA) Lisa Dyer. LPA arrived at the facility at 11:00 a.m. The licensee was present with one preschool aged child. Facility is in compliance with licensed capacity and facility ratios. Phone number and e-mail address are current. Hours: 6:00 a.m. - 6:00 p.m. At 11:22 a.m., the following was observed: the day care area of the home was inspected. Areas licensed for child care: bathroom, living room, dining room. The home was clean and orderly, with adequate heating and ventilation. There were safe, healthful and comfortable accommodations, furnishings and equipment available to children at the time of this inspection. There were a variety of books and toys for children's use. There was a working smoke detector (tested); a fully charged 4-A:60-B:C fire extinguisher; a first aid kit, and a carbon monoxide detector (tested). Licensee stated there were no firearms or bodies of water on the premises. Fireplace was blocked and closed off. There are no hazardous materials, medicines, or cleaning solutions accessible to children during this inspection. Hazardous items are kept in a high shelf in the pantry, inaccessible to children. Backyard area is still off limits to children. Children play in the front of the home. There is a shaded area. Children play with toys such as scooters, balls and a Lego Table. Licensee currently has no infants in care, but LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep web page at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and- resources/safe-sleep as an additional resource. Licensee has posted Safe Sleep handouts on a bulletin board. 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. Safe Sleep Reminders - Documentation must be maintained for each child under 24 months of age as they nap (15 minute increments). An Individual Sleeping Plan is needed for each infant up to 12 months of age. These infants must sleep on their backs. Infants breathing, skin color, and body temperature (continued)

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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: CARRIER-BROUSSARD, STACY	FACILITY NUMBER: 010216510
	VISIT DATE: 05/17/2023

NARRATIVE

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must be monitored. Licensee must be able visually observe when a child awakens from a nap. Cribs or play yards must not hinder the entrance or exit to and from the sleeping space. Mattresses must be firm, sized appropriately, and be covered with a tightly fitted sheet, with no objects hanging above or attached. Sheets must be replaced when soiled or wet.
LPA reviewed personnel, facility, and children's records at 12:43 p.m. Licensees' CPR/First Aid expires 6/18/24. Mandated Reporter Training expires 7/13/24. Last disaster drill: 5/9/23. Facility roster was current. Required postings are visible for public review. Children's files are complete. 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 maximum per day/per person will be assessed if this regulation is violated. Licensee was also reminded of the Department's Inspection authority, and the need to comply when notified that termination of an employee is necessary.
Also discussed with the licensee: supervision of children at all times; children are not to be left in parked vehicles; car seats and high chairs; Unusual Incident Reporting; paying fees on-line; advertisements; changes in on-limit areas; construction work at facility; smoking; and ill children in home.
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.

Important E-mail Addresses:
Community Care Licensing General Info: www.ccld.ca.gov.
Mandated Reporter Training:www.mandatedreporterca.com - every 2 years.
Guardian: background check process with self-service options: https://www.cdss.ca.gov/inforesources/ cdss-programs/community-care-licensing/caregiver-background-check/guardian

NO DEFICIENCIES CITED TODAY.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Stacy Carrier-Broussard.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC809 (FAS) - (06/04)

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