013415014-11-29-2023-02-CC-MMAR-CY2RDR-20231129115623

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013415014
Report Date: 11/29/2023
Date Signed: 11/29/2023 11:57:00 AM

Document Has Been Signed on 11/29/2023 11:57 AM - 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:	MARTIN, EVERSTINE		FACILITY NUMBER:	013415014
ADMINISTRATOR:	MARTIN, EVERSTINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 553-9559
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94605
CAPACITY:	14	CENSUS: 0	DATE:	11/29/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Everstine Martin/Sarah Carr		TIME COMPLETED:	12:30 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 11/29/23 Licensing Program Analysts (LPAs) Monica Mathur and Brindha Govindasamy conducted an Unannounced Required Inspection at Everstine Martin's Family Child Care Home. LPAs met with Licensee, Everstine Martin and explained the purpose of today’s inspection. Present in the home were Licensee and an Assistant. There were no daycare children present. LPAs spoke with Licensee's spouse over the phone who informed that they have not cared for daycare children since June 2023. Adults present/living in the home have Criminal Background Check Clearances. INDOOR space was inspected. It is a two story home. Main house is located on the second level. Residential area on street level is the garage converted into living space. LPAs reminded that when care is provided, the home should be child proof/ready with materials, toys, and play equipment. All detergents, cleaning compounds, medications, sharp objects and other similar items must be inaccessible to children. LPAs observed a fully charged fire extinguisher that meets State Fire Marshal standards. IN USE AREAS: Living, Dining, Kitchen, Bedroom behind dining area wall, Hallway Bathroom, Backyard (downstairs) OFF LIMIT AREAS: Rest of the home (Master bedroom, Bedroom/Bathroom downstairs) FILE REVIEW: Licensee and Assistant files were reviewed. Both their Mandated Reporter Training and CPR/First Aid certification is expired. The supervision of children was discussed, and Licensee understands she is the rpimary caregiver and that she must be present in the home during 80% of the operating hours and ensure children are supervised at all times. If no Assistant is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

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: MARTIN, EVERSTINE	FACILITY NUMBER: 013415014
	VISIT DATE: 11/29/2023

NARRATIVE

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Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

On 11/29/23 California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the Safe Sleep regulations with Licensee and the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

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: MARTIN, EVERSTINE	FACILITY NUMBER: 013415014
	VISIT DATE: 11/29/2023

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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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

In the areas that were evaluated, no regulatory violations were observed since children are not enrolled or in care. Technical Violation/Advisory Notes were issued with plan of correction deadlines for Mandated Reporter Training, EMSA Pediatric CPR/First Aid, MMR, TB clearance, Flu verification/opt out, Carbon monoxide detector.

Exit interview conducted and report was reviewed with Assistant, Sarah Carr. During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Licensee was encouraged to inform Licensing Office when daycare children and enrolled and they are ready to start caring for children. A facility inspection may be conducted to verify home is set up and free of hazards before daycare is provided.

A Notice of Site Visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

LIC809 (FAS) - (06/04)

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