013412622-2-27-2020-02-CC-CCON-BM7QZF-20200227113639

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013412622
Report Date: 02/14/2020
Date Signed: 02/27/2020 11:36:46 AM

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:	DEVIN, JEANNE		FACILITY NUMBER:	013412622
ADMINISTRATOR:	DEVIN, JEANNE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 524-8007
CITY:	ALBANY	STATE: CA	ZIP CODE:	94706
CAPACITY:	14	CENSUS: 8	DATE:	02/14/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Jeanne Devin		TIME COMPLETED:	04:20 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 Caroline Colson met with Jeanne Devin, May (Ann) Garsson, assistant and Ilana Moss, assistant for an unannounced required 1 year inspection at 12:45 PM. There are 8 preschool children present. Two (2) children's records were reviewed by the LPA and the licensee on 2/14/2020 at 2:59 PM. C1 and C2 have complete medical documentation in their files. Records were reviewed. The home was toured to conduct a health and safety inspection. The home is a one story home. The home consists of a living room, dinning room, kitchen, 2 bedrooms, 1 bathroom, laundry room, unfenced front yard with a garden, fenced back yard and garage. The off limit area is the master bedroom. Ms. Devin will use her fenced back yard for outdoor play. The home has a 2A10BC fire extinguisher and a working smoke detector and a working carbon monoxide detector. Ms. Devin states there are no firearms in the home. The second bedroom is the isolation room. She conducts fire/disaster drills every six months. Her infant CPR and First Aid certificates are current and expire on January 13, 2021. She has a first aid kit. There is one dog. This facility provides Individual Medical Services - IMS. LPA reviewed the storage of medication and equipment /supplies, and reviewed children and personnel records. LPA discussed the need to create a plan of operation. Specifics on the plan can be found in the family child care home evaluator manual (FCCH EM) Policy 102417. Please See LIC 809 C for additional information

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020

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: DEVIN, JEANNE	FACILITY NUMBER: 013412622
	VISIT DATE: 02/14/2020

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REMINDERS/RESOURCES

· Criminal Background Clearance: All assistants, volunteers, frequent adult visitors (adults are individuals 18 years of age or older) must be fingerprint cleared and associated to the facility prior to be in the presence of children in care. Failure to comply, requires an immediate civil penalty of $100 to $3000 per person, per incident.

· CCLD Complaint Hotline, 1-844-LET-US-NO (1-844-538-8766) email: LetUsNo@dss.ca.gov

· NEW LAW: Safe Sleep Regulations: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep

· Licensees and all staff are Mandated Reporters and are required to report to CCLD any suspected child abuse. The website is www.mandatedreporterca.com.

CCLD website address for obtaining licensing forms, training videos and other provider resources can be obtained at www.ccld.ca.gov

· Licensees may register to receive child care updates: www.myccl.ca.gov

Unusual incident reports were discussed and how to properly contact our department within 24 hours. The facility was advised that an unusual incident report will need to be sent within 7 days.

Analyst recommended purchasing a gate for the steps that lead to the fenced back yard. Licensee will send pictures when the gate is installed.

A site notice was posted. An exit interview was conducted. Appeal rights were discussed. This report must remain available for public review for 3 years.

There were no deficiencies cited during this inspection.

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020

LIC809 (FAS) - (06/04)

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