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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412764
Report Date: 12/05/2019
Date Signed: 12/05/2019 02:41:52 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:ANDERSON, BRENDAFACILITY NUMBER:
013412764
ADMINISTRATOR:ANDERSON, BRENDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 569-7269
CITY:OAKLANDSTATE: CAZIP CODE:
94603
CAPACITY:14CENSUS: 8DATE:
12/05/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Brenda AndersonTIME COMPLETED:
02:45 PM
NARRATIVE
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 An unannounced Annual/Random inspection was conducted by LPA Dyer. The licensee was present with her fingerprint cleared mother; 1 infant; 7 preschoolers; and 1 fingerprint cleared assistant. Licensee was in compliance with her licensed capacity and facility ratios. Hours: 7:00 am - 6:00 pm. Phone number is current. The home was inspected. Areas licensed for child care: bathroom, living room, and dining room. Off-limit areas will be made inaccessible to children by closed and/or locked doors; and visual supervision. All required forms are posted and visible for public review. There was a working smoke detector (tested); a fully charged 3-A:10-B:C fire extinguisher; 2 first aid kits, and a carbon monoxide detector. There were safe, healthful and comfortable accommodations, furnishings and equipment available to children at the time of this inspection. Fireplace was blocked. There are no hazardous materials, medicines, or cleaning solutions accessible to children during this inspection. Hazardous items are kept in a back, high shelf, inaccessible to children. Licensee stated there were no firearms or bodies of water on the premises. Back yard area is securely fenced. There is a slide, child-size tables, swing set, riding toys, a playhouse, and other toys for outside play. Children have not played outside recently due to rainy weather.
Children's files were reviewed at 12:58 pm. Licensee is conducting and documenting fire drills and utilizing the child care roster.
This facility plans to provide Incidental Medical Services–IMS. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice 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.
All staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee's Pediatric First aid/CPR cards expire 11/03/20. Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children, or an immediate civil penalty can be assessed. (continued)
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Phyllis DyerTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019
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: ANDERSON, BRENDA
FACILITY NUMBER: 013412764
VISIT DATE: 12/05/2019
NARRATIVE
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 A qualified assistant must be physically present whenever 9 or more children are in care. When an assistant is not present, the home reverts back to small family child care ratios.
New Regulations were discussed:
1. Adult Immunizations - As of September 1, 2016, a person shall not be employed/volunteer at a family child care home without immunizations against influenza, pertussis/whooping cough (Tdap), and measles (MMR). Licensee has immunization records in file.
2. Mandated Reporter Training - Beginning 1/1/18, all licensed providers and employees are required to complete training on mandated reporter duties and to renew the training every 2 years. The training is free and is available at www.mandatedreporterca.com (Child Care Provider Module).
Licensee was also reminded of the Department's Inspection authority, and the need to comply when notified that termination of an employee is necessary. The handout, "A Child Care Provider's Guide to Safe Sleep" was provided and discussed. Also discussed with the licensee: children in parked vehicles; substitutes; fingerprinting/association; changes in on-limit areas; construction work at facility; paying fees on-line and smoking. Licensee was encouraged to frequently visit the licensing website at www.ccld.ca.gov for licensing regulations, forms and updates.
For a free Indoor Radon Gas Test Kit for your facility, email: radonprogram@cdph.ca.gov or call 1-800-745-7236.

SEE 809-D for deficiencies.

The attached type B deficiency is cited today and must be corrected by the due date. This poses a potential Health and Safety risk to clients in care. Failure to correct violations will result in a civil penalty, and repeat violations will result in additional penalties.
Notice of site visit must be posted for 30 days. An exit interview was conducted. Appeal rights were given and discussed. This report must be available for public review for 3 years.
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Phyllis DyerTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019
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: ANDERSON, BRENDA
FACILITY NUMBER: 013412764
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/20/2020
Section Cited

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Mandated Reporter Training. On or before 3/30/18, a person who, on 1/1/18, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training (MRT) provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal
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mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement was not met as evidenced by interview: licensee states she has not completed the MRT Class. This poses a potential health risk to children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Phyllis DyerTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2019
LIC809 (FAS) - (06/04)
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