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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013411184
Report Date: 07/08/2019
Date Signed: 07/08/2019 03:54:19 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:CHAIREZ, MARIAFACILITY NUMBER:
013411184
ADMINISTRATOR:CHAIREZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 524-5012
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY:14CENSUS: 11DATE:
07/08/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Maria ChiarezTIME COMPLETED:
04:10 PM
NARRATIVE
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An unannounced Annual/Random site visit was conducted by LPA Susan Neeson. Met with Maria Chiarez,
Licensee. Visit began at 2:10. There are 11 children here today, 8 are preschoolers and three are infants. There are 7 adults who are fingerprint clear and associated with the facility. Her helper is her adult son. His CPR and First Aid are current to September 2019. Maria Chiarez states that she resides here.

This is a three bedroom home with one bathroom and an additional toilet and sink on the side of the house for use when the children are outside. Day care is done in two of the bedrooms and the converted and attached garage. Maria Chiarez's bedroom is off-limits. There are ample toys and equipment for the children in care. The home has central heating. The fireplace is permanently blocked with a piece of wood. There are two rabbits. There are no bodies of water. Children's records were reviewed. Maria Chairez states that there are no guns or firearms in the home or converted garage. Only the garage room is off-limits. Fire extinguisher, smoke alarm and carbon monoxide detector are in the home. The yard and covered patio in the back are used for children to play. Forms which need to be posted were discussed.

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. All forms can be downloaded at www.ccld.ca.gov and for day care updates visit www.myccl.ca.gov

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SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan NeesonTELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019
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: CHAIREZ, MARIA
FACILITY NUMBER: 013411184
VISIT DATE: 07/08/2019
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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

The following informational forms are issued: Safe Sleep regulation concepts for infants, Safe and Healthy diapering, fire and earthquake drills, car seat information, Licensee Rights, blue immunization form, AB 1207 training and Departmental Quarterly Updates for Winter 2019 and Spring 2019



No deficiencies were cited. An exit interview was given.
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan NeesonTELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019
LIC809 (FAS) - (06/04)
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