013411363-8-24-2023-52-CC-AELT-CUZTGR-20230824144333

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013411363
Report Date: 08/24/2023
Date Signed: 08/24/2023 02:44:07 PM

Document Has Been Signed on 08/24/2023 02:44 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	BROWN, SENOVIA		FACILITY NUMBER:	013411363
ADMINISTRATOR:	BROWN, SENOVIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 567-6188
CITY:	SAN LEANDRO	STATE: CA	ZIP CODE:	94577
CAPACITY:	12	CENSUS:	DATE:	08/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Senovia Brown		TIME COMPLETED:	03:00 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	Licensing Program Analyst (LPA) Andrew Elliot met with Licensee, Senovia Brown, for an unannounced Annual Random Inspection at 10:00 am on Thursday, August 24th 2023. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during this inspection was Licensee supervising 5 pre-school aged children. The home is a single-story house consisting of 3 bedrooms, 3 bathrooms, living room, dining room, family room, kitchen, backyard, and garage. The hours of operation are 6:00 AM- 6:00 PM, Monday-Friday. Day care area: Kitchen, dining area, family room (playroom), garage, 2 bathrooms and side yard. Off limit areas: 2 bedrooms, master bathroom, office, and back yard. Licensee stated she reside in the home along with a Tajuana, who has been finger print cleared. LPA inspected the house for health and safety hazards. Daycare Area is equipped with age-appropriate toys and equipment for children, indoors and outdoors. LPA observed that ants were present in the day care area and food prep area at the time of inspection. The home has a working telephone, a working smoke detector and a working carbon monoxide detector. However, LPA observed that the carbon monoxide detector was not plugged in at the time of the visit. LPA directed the licensee to plug in the carbon monoxide detector and test it. LPA observed that the carbon monoxide detector was fully functional before the end of the visit. LPA observed that the facility was equipped with a fully charged 3A-40-BC model fire extinguisher, however it was stored and sealed in its factory box at the time of inspection. LPA directed the licensee to ready the fire extinguisher for immediate use during the visit and observed that the LPA readied the fire extinguisher for immediate use prior to the end of the visit.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew Elliott	TELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BROWN, SENOVIA	FACILITY NUMBER: 013411363
	VISIT DATE: 08/24/2023

NARRATIVE

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There are ample of age-appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs, or any other bodies of water during today's inspection. There were no pets present in the home. The home has electrical outlet covers and maintains a First Aid Kit in the home. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. LPA observed that the licensee had a posted plan for fire and earthquake emergency evacuations, and that a log for recording emergency drills was posted, however the log was not filled in with any information. LPA directed the licensee to conduct a fire and earthquake drill with the children present during the inspection and observed that the licensee successfully performed an emergency evacuation. LPA then directed and observed the licensee to record the time of the drill. The last emergency drill was recorded on 08/24/2023 at 11:45 am. LPA observed that all required postings were present in the facility.
LPA reviewed children’s files and staff files. LPA observed that licensee only had children’s files organized for two of the five pre-school aged children present. This is a violation of multiple California Code of Regulations (CCRs) and Health and Safety Codes (HSCs). Specifically, CCR 102418 (g), the requirement that a licensee must maintain a current roster of children, document each child’s immunization's, CCR 102419(d) and 102421 (a) documentation of parent’s rights, 102421(b) and 102417(g)(7) requirement to maintain a copy of children’s emergency information in their file, 102419(d)(1), maintenance of signed receipts of parent’s rights form in children’s files, and 102417(m)(3), parent’s notification of insurance liability. The failure to maintain children’s files for 3 of the 5 children present in care, and to keep critical information readily available for 3 of the 5 children in care constitutes multiple violations of CCRs and HSCs that both pose an immediate risk to children in care and additional potential risks to children in care, as a result, multiple type B violations will be issues for a failure to maintain the aforementioned records. LPA directed the licensee to and organize children’s records as soon as possible. LPA informed the licensee that she would need to provide proof of correction for these violations by 08/28/2023. If not, LPA informed the licensee would arrange for a case managed visit to follow up.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew Elliott	TELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BROWN, SENOVIA	FACILITY NUMBER: 013411363
	VISIT DATE: 08/24/2023

NARRATIVE

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LPA also observed that the licensee did not keep her facility files, or her own personnel records organized in a file, which is a violation of CCR 102416.1(a)(1) and 102416.3(a)(6). Most of the licensee’s information is on file with CCLD and organized within her facility file, so these violations do not pose an immediate risk to children’s wellbeing. As such Technical Violations will be issues for the licensee’s failure to maintain personal files. LPA checked to see if the licensee could produce proof of CPR/First Aid Certification and Mandated Reporter Training Completion, as these items expire. LPA observed that the licensee was able to provide proof of completion of CPR/First Aid Certification, and her current authorization expires on 12/2024. LPA observed that the licensee was not able to provide proof of Mandated Reporter Training Completion, which is a violation of HSC 1596.8662(b)(1). A type B violation will be issues for this violation as it constitutes a potential risk to children’s health and safety.
To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew Elliott	TELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BROWN, SENOVIA	FACILITY NUMBER: 013411363
	VISIT DATE: 08/24/2023

NARRATIVE

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LPA discussed the safe sleep regulations with licensee 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 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

Exit interview conducted and report was reviewed with the licensee Senovia Brown.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew Elliott	TELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/30/2023 12:21 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 08/29/2023 03:52 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BROWN, SENOVIA	FACILITY NUMBER: 013411363
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on file review, the licensee did not comply with the section cited above in 1 out of 1 count which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/31/2023
	Plan of Correction
1 2 3 4	Licensee will provide LPA proof of completion of mandated reporter training by 08/31/2023.

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in 3 out of 5 counts which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/31/2023
	Plan of Correction
1 2 3 4	Licnesee shall obtain immunization records for all children in care by 08/31/2023.

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: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew Elliott	TELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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Document is an Amendment of Original Document on 08/29/2023 03:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BROWN, SENOVIA	FACILITY NUMBER: 013411363
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102419(d)

Admission Procedures and Parental and Authorized Representative's Rights

(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and file review, the licensee did not comply with the section cited above in 3 out of 5 counts which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/31/2023
	Plan of Correction
1 2 3 4	LPA will obtain proof of parents rights notifications by 08/31/2023.

Type B

Section Cited

CCR

102421(a)

Child's Records

(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and file review, the licensee did not comply with the section cited above in 3 out of 5 out of counts which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/31/2023
	Plan of Correction
1 2 3 4	Licensee will provide proof of correction by 08/31/2023.

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: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew Elliott	TELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC809 (FAS) - (06/04)

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Document is an Amendment of Original Document on 08/29/2023 03:59 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BROWN, SENOVIA	FACILITY NUMBER: 013411363
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102421(b)

Child's Records

(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and file review, the licensee did not comply with the section cited above in 3 out of 5 counts which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/31/2023
	Plan of Correction
1 2 3 4	Licesee will provide LPA will proof that she has gathered completed emergency cards for each child in care by 08/31/2023.

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and file review, the licensee did not comply with the section cited above in 3 out of [total count 5 total counts which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/31/2023
	Plan of Correction
1 2 3 4	Licensee will provide LPA will proof the children's files have been compelted by 08/31/2023.

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: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew Elliott	TELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC809 (FAS) - (06/04)

Page: 7 of 14

Document is an Amendment of Original Document on 08/29/2023 04:06 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BROWN, SENOVIA	FACILITY NUMBER: 013411363
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and file review, the licensee did not comply with the section cited above in 3 out of 5 counts which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/31/2023
	Plan of Correction
1 2 3 4	Licensee will provide LPA will a complete and updated roster by 08/31/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew Elliott	TELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC809 (FAS) - (06/04)

Page: 8 of 14

Document is an Amendment of Original Document on 08/29/2023 04:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BROWN, SENOVIA	FACILITY NUMBER: 013411363
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102419(d)(1)

Admission Procedures and Authorized Representatives Rights

(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. The bottom portion of this form must be kept in the child’s file as proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver background Check Process, LIC 995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and file review, the licensee did not comply with the section cited above in 3 out of 5 counts, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/31/2023
	Plan of Correction
1 2 3 4	Licensee will provide LPA proof that they have orgainzed a file with all of the required forms, signed and compelted by parents or apporiate stake holders, by 08/31/2023.

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: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew Elliott	TELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC809 (FAS) - (06/04)

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