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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013414711
Report Date: 05/29/2019
Date Signed: 05/29/2019 05:54:48 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:GILFORD, MARLENEFACILITY NUMBER:
013414711
ADMINISTRATOR:GILFORD, MARLENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 533-0516
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:14CENSUS: 9DATE:
05/29/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Marlene GilfordTIME COMPLETED:
06:00 PM
NARRATIVE
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LPA Lisa Dyer and LPM Ann Robinson met with Marlene Gilford for an Case Management inspection. During numerous inspections in the past licensee was asked if a firearm was present in the home, but answered no.

Licensee was aware that a firearm was present in the home. She stated that she kept the firearm for the safety of her home. She has had the firearm for over 20 years. She admitted that she had not told licensing about the firearm present in the home.

Licensee had a firearm at the premises that was not stored according to CCL regulations.

The licensee today is being cited for Conduct Inimical.

The attached type A violation is cited today and must be corrected by the due date. This poses an immediate 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. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing. Assembly Bill 633 Fact Sheet was given and discussed with the licensee.

Notice of site visit was posted at the time of the inspection and 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: 05/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
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: GILFORD, MARLENE
FACILITY NUMBER: 013414711
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/30/2019
Section Cited
CCR
102402(a)(3)
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Conduct in the operation or maintenance of a family day care home which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California. This requirement was not met as evidenced by Interview.
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Licensee understands that she must be forthcoming with CCL personnel when information is requested, and must answer truthfully to all requests.
licensee must provide a statement stating that she will answer truthfully to all requests from CCL in the future.
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 Licensee stated that she did not answer truthfully when asked if she had a firearm on the premises. This poses an immediate health risk to the Health and Safety 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: 05/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
LIC809 (FAS) - (06/04)
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