013415672-7-22-2024-52-CC-JJAN-D7EQ9J-20240722115826

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013415672
Report Date: 07/22/2024
Date Signed: 07/22/2024 11:58:36 AM

Document Has Been Signed on 07/22/2024 11:58 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	FUHRMAN, KIMBERLY		FACILITY NUMBER:	013415672
ADMINISTRATOR:	FUHRMAN, KIMBERLY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 304-9238
CITY:	FREMONT	STATE: CA	ZIP CODE:	94538
CAPACITY:	14	CENSUS: 3	DATE:	07/22/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Kimberly Fuhrman		TIME COMPLETED:	12:15 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 7/22/2024 at 10:00AM Licensing Program Analyst (LPA) Jaleesa Jackson met with Licensee Kimberly Fuhrman for an Annual Random visit. Present during the inspection was the Licensee, her fingerprint cleared adult daughter and 3 preschool age children. Licensee’s live in the home with her adult daughter and her husband. The facility operates from 5:00AM – 5:00PM, Monday - Friday. ON LIMITS AREA: Bedroom #1 (Left side of Hallway), Bedroom #2 (Left Side of Hallway), Hallway Bathroom, Kitchen, Living Room, Family Room (main childcare area), and Backyard OFF LIMITS AREA: Master Bedroom and Bathroom, Dining Room, and Garage ISOLATION AREA: Living Room The facility is a single-story home owned by the Licensee. The inside of the home is observed to have age-appropriate materials for the children. During today's visit all toxins, cleaning products, personal medications, and hazardous materials were observed to be in inaccessible areas. Licensee has stated that there are no firearms and no pets in the home. The home has a fully charged 3A40BC fire extinguisher in the home. There is a working smoke detector and carbon monoxide detector in the home. There is a wood burning stove in between the dining area and the living room that is blocked off and made inaccessible to the children in care. Licensee also holds a waiver for the fireplace. The home is equipped with central heat and air for proper ventilation. Licensee provides all food for the children. All food that is brought from the children’s home will be properly labeled and stored. Licensee stated that she does not transport children. Continued 809-C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Jaleesa Jackson	TELEPHONE: (510) 368-0021
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024

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 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: FUHRMAN, KIMBERLY	FACILITY NUMBER: 013415672
	VISIT DATE: 07/22/2024

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

LPA reviewed all 3 children's files. Licensee’s Health and Safety training has been completed and Pediatric CPR and First Aid training is completed and expires 9/17/2024. All required forms are posted and visible for public view in the family room. Licensee’s fire drill log is complete with the last drill logged 4/16/2024.

No deficiencies were cited during the inspection.

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.

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 discussed 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Continued 809-C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Jaleesa Jackson	TELEPHONE: (510) 368-0021
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: FUHRMAN, KIMBERLY	FACILITY NUMBER: 013415672
	VISIT DATE: 07/22/2024

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

Licensee was informed of the MyChildCarePlan.org website; 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.

During the exit interview, the LICENSEE Kimberly Fuhrman, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

Exit interview conducted and report was reviewed with the licensee Kimberly Fuhrman.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Jaleesa Jackson	TELEPHONE: (510) 368-0021
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5