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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415672
Report Date: 07/27/2021
Date Signed: 07/27/2021 04:26:15 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:FUHRMAN, KIMBERLYFACILITY NUMBER:
013415672
ADMINISTRATOR:FUHRMAN, KIMBERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 304-9238
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:14CENSUS: 6DATE:
07/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Kimberly FuhrmanTIME COMPLETED:
04:30 PM
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On July 27, 2021 at approximately 2:45pm Licensing Program Analyst (LPA) Russ Haderer met with licensee Kimberly Fuhrman for the purpose of conducting an unannounced 1-year annual inspection for Health and Safety compliance. Present for today’s inspection was the licensee, her TB and fingerprint cleared husband and adult daughter. There were 6 children in care (two infants, 1 toddler and 3 school age children). The hours of operation are Monday-Friday, 5:00 AM to 5:00PM.

The facility is a single story 3 bedroom, 2 bath home with an attached 2-car garage. It is owned by the licensee and contains a large family room (day care area); dining room, kitchen, living room an enclosed (fenced) side and backyard areas. The home is neat and clean with heating and ventilation for safety and comfort. Per the licensee, the ISOLATION AREA will be on the sofa in the living room away from the other children in care.

On-limit-areas include: Large family room (day care area), kitchen, dining room, hallway leading to the main house bathroom, all bedrooms in the home. Licensee was reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) such as cleaning products. There are no accessible hazardous cleaning chemicals or other liquids in the on-limits area.

Off-limit-areas include: The master bathroom and 2-car attached garage. The off-limit area will be inaccessible by closed and/or locked doors, and/or by adult supervision.



There is a double-sided fireplace (accessible from dining room and living room) with glass doors and one side and the second opening is blocked with a bench for seating.

Disaster drills are conducted, the last one was February 10, 2021. Per licensee, there are no firearms in the home. ]
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
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 3
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: FUHRMAN, KIMBERLY
FACILITY NUMBER: 013415672
VISIT DATE: 07/27/2021
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Facility has a waiver from 12/26/2003 for wood burning stove permitted but never to be used during hours of day care. If used outside hours of daycare, it will be cool to the touch by the time children are in care. Central heating furnace will be maintained and used for heat for the home during daycare hours. Waiver is properly posted.

Licensee has ample age-appropriate toys and learning materials. The home has a fully charged 3A40BC fire extinguisher stored in the food cupboard in the kitchen. There is a working telephone, a smoke detector and carbon monoxide detector (tested and functioning) located in the main hallway. The licensee’s Health and Safety training is completed, and CPR and First Aid certificates are current and expire 08/22/2022. Mandated Reporter certificate has not been done, licensee instructed to complete this and print the certificate within 5 days. Licensee is in compliance with the immunization laws which pertains to day care providers.

LPA reminded the licensee of the following; Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. .

LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: FUHRMAN, KIMBERLY
FACILITY NUMBER: 013415672
VISIT DATE: 07/27/2021
NARRATIVE
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Child files were reviewed, roster was available for all years of operation.

For licensing updates email childcareadvocatesprogram@dss.ca.gov to be added to the email list.

There were no deficiencies issued during today’s inspection: This report will remain on file for 3 years.

An exit interview was conducted, and a Notice of Site Visit was printed and posted at time of inspection and must remain posted for 30 days



A review of operating safely during the Covid-19 pandemic (RAST) was conducted.

Exit interview was conducted with licensee, LPA left the home at 4:30pm.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3