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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013414465
Report Date: 05/03/2022
Date Signed: 05/03/2022 01:30:46 PM


Document Has Been Signed on 05/03/2022 01:30 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 STE 1102
OAKLAND, CA 94612



FACILITY NAME:RIDDLE, MARYFACILITY NUMBER:
013414465
ADMINISTRATOR:RIDDLE, MARYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 797-9967
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:14CENSUS: 9DATE:
05/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Mary RiddleTIME COMPLETED:
01:40 PM
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On 05/03/2022 approximately at 10:25AM Licensing Program Analyst (LPA) Kelly Phan arrived at for an unannounced required inspection, and met with Licensee Mary Riddle. Present for this inspection was the licensee, her fingerprinted and associated adult daughter/assistant, 1 infant, 4 preschoolers, and 4 school aged children. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 8:00am to 5:30pm.

ON LIMITS: hallway bathroom, fenced backyard, dining room, living room, kitchen, and family room; isolation area is kitchen area
OFF LIMITS: garage, left and right side yards, and all bedrooms. Off limit areas are inaccessible by closed and/or locked doors, and visual supervision.

The home is single story, which is neat and clean, with heating and ventilation for safety and comfort. There were ample age appropriate toys and games that were observed to be safe and in good condition. At 10:40AM, LPA toured the ON LIMIT areas and observed a knife with guard cover in the kitchen area. LPA asked about the kitchen knife, and licensee states that she was not aware that it was in the drawer and usually have a close supervision with children in care. LPA informs licensee to move it to an inaccessible area, and licensee understood and stored it away. LPA also informs licensee that a TV will be issued and reminded licensee to store all potential hazardous items away from children. Licensee was also informed that the red fence that blocks the right side yard is broken; licensee states that she is aware and will keep close supervision on the children in care while they are outside. There was a fully charged 2A10BC fire extinguisher, working dual carbon monoxide and smoke detector, and telephone. The home has a fireplace but is blocked off by cabinets. Per licensee, there are no firearms or any bodies of water in the home. Licensee has 4 cats, a dog, and fish at her facility. The licensee conducts and documents fire drill log indicates a drill was conducted 04/01/2022. All required licensing documents are posted and visible for public review.

SEE LIC 809 C
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly PhanTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4


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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: RIDDLE, MARY
FACILITY NUMBER: 013414465
VISIT DATE: 05/03/2022
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At 11:40am, 6 children's files were reviewed and there were 4 out of 6 children's file that was missing LIC 613A (Children's Personal Rights and LIC 282 (Affidavit Regarding Liability Insurance). LPA asks licensee to provide corrections by 5/6/2022. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. Licensee nor her adult daughter does not have proof of the required immunization. The licensee and her daughter has have required mandated reporter training that is completed as of 08/09/2021. Both has CPR and First Aid training are also updated as of 06/13/2022. LPA also verified with licensee's adult daughter that she would transport children per family's request. LPA informs licensee that the individual who transports children in care will have to have a valid driver's license, have appropriate child resistant devices, and motor vehicle used for transportation is maintained in good condition. Licensee is also reminded that children are not allowed to be alone in the motor vehicle and shall not exceed seating capacity.

There were no deficiencies cited for today's inspection:
At 12:20PM, LPA asked if licensee has her immunization records; she states that she usually does not take the flu shot but she does not have her immunization with her. LPA states that she would have to have a declaration for declining the flu shot and to send proof of immunization and sleep logs to LPA; however licensee states she is NOT able to provide a deadline for LPA for her and her adult daughter's immunizations and will provide updates to LPA.

Appeal rights and a notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00. Exit interview conducted and report was reviewed with licensee Mary Riddle.

SEE LIC 809 C


SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly PhanTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: RIDDLE, MARY
FACILITY NUMBER: 013414465
VISIT DATE: 05/03/2022
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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. This facility does not provides IMS to children in care. 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: http://www.ada.gov/childqanda.htm.”

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 $500.00 maximum per day/per person will be assessed if this regulation is violated.

SEE LIC 809 C

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly PhanTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: RIDDLE, MARY
FACILITY NUMBER: 013414465
VISIT DATE: 05/03/2022
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Licensee was reminded that California Law requires licensed Child Care Centers to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Facility Representative that all forms can be downloaded at www.ccld.ca.gov and encouraged the Facility Representative to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

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/process.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly PhanTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4