013415302-11-3-2022-02-CC-ASIH-CKTSHP-20221103135351

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013415302
Report Date: 11/03/2022
Date Signed: 11/03/2022 01:55:18 PM

Document Has Been Signed on 11/03/2022 01:55 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	SAPALICIO, ROSEMARIE & ALAN		FACILITY NUMBER:	013415302
ADMINISTRATOR:	SAPALICIO, ROSEMARIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 995-8187
CITY:	ALAMEDA	STATE: CA	ZIP CODE:	94501
CAPACITY:	14	CENSUS: 2	DATE:	11/03/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Alan and Rosemarie Sapalicio		TIME COMPLETED:	02:15 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 11/03/2022 Licensing Program Analyst (LPA) Arminder Singh met with Licensees, Alan and Rosemarie Sapalicio and explained the purpose of today's visit. There are 2 children present today. Children were engaged in various activities when LPA arrived. LPA reviewed record of two (2) children today (C1-C2). Children's file included Licensing documents per regulation and immunization records. The home was toured to conduct a health and safety inspection. The Licensee's hours of operation are Monday-Friday, 8:00AM-5:30PM. Licensee has a working telephone in the home. The home is a one story home with a basement below, an attic converted into a bedroom, and a garage located on side of the home. The home consists of three bedrooms, one bathroom, kitchen, sun room, and living room. The basement is converted into a bedroom which has a bathroom. The outdoor area is fully fenced which has an law unit. ON LIMIT AREAS are the living room, kitchen, sun room, two bedrooms on first floor, bathroom located on first floor, and outdoor area. OFF LIMIT AREAS is the attic, basement, garage, and in law unit. Off limits area will be made inaccessible by closed and/or locked doors, barricades, and visual supervision. ISOLATION AREA is the living room.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SAPALICIO, ROSEMARIE & ALAN	FACILITY NUMBER: 013415302
	VISIT DATE: 11/03/2022

NARRATIVE

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The home is sanitary, safe and orderly, with central heating and ventilation for safety and comfort. LPA observed required Postings on the wall. LPA observed: fully charged 2A10BC fire extinguisher, working smoke and carbon monoxide detector. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets and out of reach of children. LPA reminded Licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. Licensee does not have any firearms at facility. Licensee does not have any pets in the home.

The Licensees have current CPR and First Aid certification and expires on 07/2024.

LPA reminded Licensee that the mandated reporter training certificates are to be renewed every two years. Licensee was reminded that fire/disaster drills are to be conducted every six months. Last fire drill was conducted on June 2022.

Outdoor yard is fully fenced with ample age appropriate toys. In today's visit there were no bodies of water in outdoor areas.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SAPALICIO, ROSEMARIE & ALAN	FACILITY NUMBER: 013415302
	VISIT DATE: 11/03/2022

NARRATIVE

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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.

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.

LPA discussed the safe sleep regulations with 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 licensees 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.

There were no deficiencies in today's visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with the Licensees, Alan and Rosemarie Sapalicio

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

LIC809 (FAS) - (06/04)

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