013414643-6-16-2023-02-CC-ILOA-CSUVJM-20230616162856

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013414643
Report Date: 06/16/2023
Date Signed: 06/16/2023 04:29:07 PM

Document Has Been Signed on 06/16/2023 04:29 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:	RUYFFELAERE, DIANNE		FACILITY NUMBER:	013414643
ADMINISTRATOR:	RUYFFELAERE, DIANNE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 525-1619
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94708
CAPACITY:	14	CENSUS: 3	DATE:	06/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Sharmila & Nihara Gregory		TIME COMPLETED:	04:36 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 June 16, 2023 at approximately 1:25pm Licensing Program Analyst (LPA) Indira Loza met with Assistants Carmel & Esther Gregory to conduct a Required 1-year annual inspection. Present for today’s inspection were the two fingerprint cleared assistants and three preschool-age children. The facility is in ratio today. Hours of operation are Monday - Friday 8:30am to 3:30pm.

The facility is a three story home with the first floor consisting of one bedroom, one bathroom, living room, and kitchen. The second floor consists of four bedrooms, one bathroom, and a family room. The third floor consists of an in-law unit with a kitchen with a small dining area, a bathroom, two bedrooms, two closed off storage areas, a living room, and a backyard

ON LIMIT AREAS: The two bedrooms of the in-law unit (third floor), the kitchen, bathroom, living room, and the backyard.

OFF LIMIT AREAS: The entire first and second levels of the home. The off-limit areas will be inaccessible by child gates, closed and/or locked doors and adult supervision.
ISOLATION AREA: Is outside with an assistant

The home has heating and ventilation for safety and comfort. The home has a fully charged 2A10BC fire extinguisher, smoke and carbon monoxide detectors, and a working telephone. Licensee has ample age-appropriate toys and learning materials inside and outside the home. Toxins, medicines, and hazardous items were inaccessible during today's inspection. The Licensee has utilized the backyard for outdoor play. LPA reviewed three children's files and two staff files which were found to be complete. The facility roster was reviewed, and a copy obtained. The Licensee has Liability insurance. First Aid certificates for the Licensee and Assistants were current.

The Assistant was reminded that CPR/1st Aide and Mandated Reporter is to be renewed every two years. The Mandated Reporter training can be taken at www.mandatedreporterca.com Incidental Medical Services *********************************Report Continues on LIC 809-C*******************************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 3 of 7

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: RUYFFELAERE, DIANNE	FACILITY NUMBER: 013414643
	VISIT DATE: 06/16/2023

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
26
27
28
29
30
31
32

(IMS) policy was discussed. For IMS information see PIN 22-02. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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

The Licensee and Assistants were also reminded to sign up for the Provider Information Notifications (PINS) to get notifications regrading updates to the Title 22 Regulations.

The Assistant 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.

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.

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.

See LIC 809-D for a Type B citation.

Exit interview conducted and report was reviewed with Assistant Esther Gregory.

Report and Appeal Rights were provided.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC809 (FAS) - (06/04)

Page: 6 of 7

Document Has Been Signed on 06/16/2023 04:29 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: RUYFFELAERE, DIANNE	FACILITY NUMBER: 013414643
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the Licensee did not comply with the section cited above as there was not a fire drill conducted for more than 6 months which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/14/2023
	Plan of Correction
1 2 3 4	Licensee shall email a copy of a current fire drill log.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC809 (FAS) - (06/04)

Page: 7 of 7