013412622-12-7-2023-02-CC-CFES-CYAUDU-20231207143008

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013412622
Report Date: 12/07/2023
Date Signed: 12/07/2023 02:30:14 PM

Document Has Been Signed on 12/07/2023 02:30 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:	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: 4	DATE:	12/07/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	12:24 PM
MET WITH:	Jeanne Devin		TIME COMPLETED:	02:40 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	On 12/7/2023 at 12:24pm, Licensing Program Analysts (LPAs) Catherine Fernandes and Janai McClain met with Licensee Jeanne Devin for an Unannounced Required Inspection. Present during the inspection were four preschoolers in care and one fingerprint cleared assistant. Residing in the home is Licensee. Licensee’s home was toured for a health and safety inspection. The facility operates 8:00am – 5:00pm, Monday - Friday. The home is a single story house that consists of two bedrooms and one bathroom. The entrance to the day care is the front door. The inside and outside of the home were observed to be neat, clean with age-appropriate materials and toys for the children. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. Licensee has stated that there are no firearms in the home. There is a dog named Stanley that is around the children in care. ON LIMITS AREA: The living/dining room which is the main area of the day care, the first bedroom on the left side, the bathroom, the kitchen, the laundry room which is used as walk through space to gain access to the backyard, the right side of the deck, the fenced in backyard, the left side of the yard when facing towards the house and the front yard, Licensee was reminded that while in the front yard 100 percent supervision is required all times. OFF LIMITS AREA: the master bedroom at the end of the hall, the right side of the deck that is fenced off, under the deck and the right side of yard when facing the house which will be inaccessible by closed and/or locked doors or visual supervision. ISOLATION AREA: in the bedroom The home has a fully charged 2A10BC fire extinguisher in the kitchen, a working smoke detector in the living room and carbon monoxide detector in the kitchen. Licensee has a working telephone, and all required forms are posted and visible for public view in the childcare room.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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: DEVIN, JEANNE	FACILITY NUMBER: 013412622
	VISIT DATE: 12/07/2023

NARRATIVE

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The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 11/20/23. The Licensee's CPR and First Aid certificate is current and expires on 11/2025. The Licensee was reminded of the responsibility as a mandated reporter and has provided proof of the required training for all people caring for children which was conducted on 11/2023. LPA did not observe a body of water in or around home. LPA reviewed four children’s files and all staff files and obtained a current facility roster.

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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

REPORT CONTINUES ON 809C.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: 12/07/2023

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

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, the LICENSEE Devin, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies were observed during today's inspection

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

Exit interview conducted and report was reviewed with the licensee

Appeal rights, report and Notice of site visit provided.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC809 (FAS) - (06/04)

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