013414296-10-6-2022-02-CC-PDYR-CJXU95-20221006152234

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013414296
Report Date: 10/06/2022
Date Signed: 10/06/2022 03:22:55 PM

Document Has Been Signed on 10/06/2022 03:22 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:	LEWIS, PAMELA		FACILITY NUMBER:	013414296
ADMINISTRATOR:	LEWIS, PAMELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 635-2303
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94605
CAPACITY:	14	CENSUS: 0	DATE:	10/06/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:12 AM
MET WITH:	Pamela Morse		TIME COMPLETED:	03:35 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	An unannounced Required - 1 Year inspection was conducted by Licensing Program Analyst L. Dyer. LPA arrived at the facility at 9:12 a.m. There were no children present on the date of this inspection. Phone number and e-mail address are current. Hours: 6:00 a.m. - 6:00 p.m. The day care area of the home was inspected. Off-limit areas will be made inaccessible to children by closed and/or locked doors; and visual supervision. The home was clean and orderly, with adequate heating and ventilation. There were safe, healthful and comfortable accommodations, furnishings and equipment available to children at the time of this inspection. There were a variety of books and toys for children's use. Facility has functioning cell phone, smoke/carbon monoxide detector combo and fire extinguisher (3A:40:BC). Licensee stated there were no firearms or bodies of water on the premises. No fireplace. There are no hazardous materials, medicines, or cleaning solutions accessible to children during this inspection. Hazardous items are kept in the kitchen, inaccessible to children. Back yard area is securely fenced. Licensee has outdoor toys for child play. Licensee currently has 1 infant in care over 12 months of age, in which a sleeping plan is not required. LPA, however, discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep web page 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. Older children sleep on cots. Licensee states sheets are replaced when soiled or wet, and individual bedding is only used by one child only. Soiled bedding is placed in a closed container and is inaccessible until washed. Bedding is washed weekly or before used by another child. LPA reviewed personnel, facility, and children's records at 1:11 p.m. Licensees' CPR/First Aid expires July, 2024. Last disaster drill completed on 10/06/22. Facility roster is available for review. Required postings are visible for public review. (continued)

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

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: LEWIS, PAMELA	FACILITY NUMBER: 013414296
	VISIT DATE: 10/06/2022

NARRATIVE

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500 maximum per day/per person will be assessed if this regulation is violated.
Licensee was asked about her excluded son, Kenneth Aubrey. She stated he does not live in the home. Licensee provided proof of Notification of Parents Regarding Removal/Exclusion in each child's file. She was requested to continue to maintain these forms in each child's file.
Licensee was also reminded of the Department's Inspection authority, and the need to comply when notified that termination of an employee is necessary. Also discussed with the licensee: supervision of children at all times; children are not to be left in parked vehicles; car seats and high chairs; Unusual Incident Reporting; advertisements; changes in on-limit areas; construction work at facility; paying fees on-line; smoking; ill children in home, and the Guardian background check process.
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

Important E-mail Addresses: Community Care Licensing:www.ccld.ca.gov
Mandated Reporter Training:www.mandatedreporterca.com

SEE 809-D for deficiencies.

The attached type B deficiencies are 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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Pamela Lewis.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/06/2022 03:22 PM - It Cannot Be Edited

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: LEWIS, PAMELA	FACILITY NUMBER: 013414296
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662b

Mandated Reporter Training. On or before 3/30/18, a person who, on January 1, 2018, 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 mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
	Deficient Practice Statement
1 2 3 4	This requirement was not met as evidenced on record review: the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/07/2022
	Plan of Correction
1 2 3 4	Licensee will complete the required Mandated Reporter Training by the POC due date.

Type B

Section Cited

HSC

102416.1a

Personnel Records. Personnel records shall be maintained on each employee and shall contain specified information.
	Deficient Practice Statement
1 2 3 4	Based on record review of 3 employee records, the licensee did not comply with the section cited above in 2 out of 3 records which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/07/2022
	Plan of Correction
1 2 3 4	Licensee will insure that all personnel records are complete and contain specified information.

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: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

LIC809 (FAS) - (06/04)

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