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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013416167
Report Date: 07/12/2023
Date Signed: 07/12/2023 04:51:32 PM


Document Has Been Signed on 07/12/2023 04:51 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:COLEMAN, BEVERLYFACILITY NUMBER:
013416167
ADMINISTRATOR:COLEMAN, BEVERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 978-0744
CITY:OAKLANDSTATE: CAZIP CODE:
94603
CAPACITY:14CENSUS: 4DATE:
07/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Beverly ColemanTIME COMPLETED:
05:05 PM
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On 7/12/23 at 12:40 pm, Licensing Program Manager (LPM) Loretta Dyson and Licensing Program Analyst (LPA) Randall Dunevant arrived at the home for an unannounced Required Inspection. LPM and LPA met with Beverly Coleman. There were 4 preschool age children and the licensee's teenage grandchild also present.

LPM and LPA toured the areas of the home used to provide care for children, to complete a health and safety inspection. The home is a two story home. The upper level of the home consists of the living room, dining room, kitchen, one bedroom and one bathroom. The lower level of the home consists of two bedrooms, one bathroom, the child care room, the garage and laundry room. The on limit areas consist of the child care room and the bathroom on the lower level. The off limit areas include the upper level of the home and the bedrooms, garage and laundry room on the lower level. One of the off limit bedrooms is accessible to children as the door to the room needs repair. LPM and LPA observed a cat litter and other items that should not be accessible to children in care inside the bedroom. The other off limit areas are made inaccessible by closed and/or locked doors and visual supervision. The child care area has sufficient heating and ventilation. LPM and LPA observed that some areas of the child care room and outdoor play area need to be reorganized and repaired. The isolation area will be the area outside of the laundry room, away from other children in care. The front yard is used for outdoor play. The front yard is fenced, however there is debris that needs to be cleared and the area on the side of the home needs to be made inaccessible as children have access to the trash bins and other items that could be hazardous to children. The licensee was advised to have 100% visual when children are in the front yard.

LPM and LPA observed an ample supply of age appropriate toys and activities. LPM and LPA observed that there are toys that need repair and to be cleared of debris. LPM and LPA did not observe any bodies of water or medications accessible to children today. LPM and LPA observed cleaning product accessible in the hallway close to the bathroom. The home is equipped with a working smoke and carbon monoxide detector, working telephone, and first aid kit. The 2A10BC fire extinguisher that is available is not fully charged. The licensee has not yet completed the required mandated reporter training. The licensee stated that there are
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Loretta DysonTELEPHONE: 510-695-0243
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2023
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: COLEMAN, BEVERLY
FACILITY NUMBER: 013416167
VISIT DATE: 07/12/2023
NARRATIVE
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no firearms in the home. The licensee has not conducted fire/disaster drills since 2021 according to the logs provided and reviewed during the inspection. LPM and LPA reviewed 2 children’s files and found them to be complete with all of the required documents. The licensee was reminded that walkers, baby bouncers and drop down cribs are not allowed in day care facilities. LPM did not observe any of these items during the inspection today.

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 [or facility representative] 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 22-02CCP. 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/.

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

SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Loretta DysonTELEPHONE: 510-695-0243
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
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: COLEMAN, BEVERLY
FACILITY NUMBER: 013416167
VISIT DATE: 07/12/2023
NARRATIVE
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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.

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

See 809D for deficiencies being cited today.

Exit interview conducted and report was reviewed with the licensee, Beverly Coleman.

SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Loretta DysonTELEPHONE: 510-695-0243
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 07/12/2023 04:51 PM - It Cannot Be Edited

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: COLEMAN, BEVERLY
FACILITY NUMBER: 013416167

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)


This requirement is not met as evidenced by: The gate leading to the upstairs area was open and accessible to children; the gate blocking the wall heater needs repair; there is a bottle of cleaning product- CLR that was accessible to children in the hallway near the bathroom. The fire extinguisher is not fully charged and ready to use.
Deficient Practice Statement
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102417(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/13/2023
Plan of Correction
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The licensee will secure the gate that surrounds the wall heater, ensure that the gate leading to the upper level is secure at all times, and remove the bottle of cleaning product. The licensee will submit a plan regarding how she will replace the fire extinguisher with one that is the correct size or recharge the existing fire extinguisher. The plan will indicate how soon the licensee will be able to replace or recharge the extinguisher.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Loretta DysonTELEPHONE: 510-695-0243
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2023
LIC809 (FAS) - (06/04)
Page: 4 of 8


Document Has Been Signed on 07/12/2023 04:51 PM - It Cannot Be Edited

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: COLEMAN, BEVERLY
FACILITY NUMBER: 013416167

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)


This requirement is not met as evidenced by: Each family child care home shall conduct fire drills and disaster drills at least once every six months.
Deficient Practice Statement
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Based on observation during the inspection, the licensee did not comply with the section cited above as evidenced by review of log which indicates that fire/disaster drills were last conducted in 2021. This posesa poten tial health, safety or personal rights risk to persons in care.
POC Due Date: 08/11/2023
Plan of Correction
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The licensee will conduct a fire and disaster drill and send Licensing a copy of the updated log as evidence of completion.
Type B
Section Cited
HSC
1596.8662(b)(1)


This requirement is not met as evidenced by:(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
Deficient Practice Statement
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Based on interview with the licensee, the licensee did not comply with the section cited above as evidenced by the licensee's statement that they has not completed the required mandated reporter training. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/11/2023
Plan of Correction
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The licensee will complete the required mandated reporter training and provide proof of completion to Licensing by 8/11/23. The training is to be completed at the website: www.mandatedreporterca.com.
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: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Loretta DysonTELEPHONE: 510-695-0243
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2023
LIC809 (FAS) - (06/04)
Page: 5 of 8


Document Has Been Signed on 07/12/2023 04:51 PM - It Cannot Be Edited

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: COLEMAN, BEVERLY
FACILITY NUMBER: 013416167

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)


This requirement is not met as evidenced by: Commencing on September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has immunized against influenza, pertussis and measles. Each employee or volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
Deficient Practice Statement
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Based on interview with the licensee, the licensee did not comply with the section cited by providing proof of immunization for measles, pertussis and influenza vaccination, or a statement decling the influenza vaccination, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/11/2023
Plan of Correction
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The licnesee will provide proof of immunization for measles, pertussis and influenza vaccination, or a statement decling the influenza vaccination, to Licensing by 8/11/23.
Type B
Section Cited
CCR
102417(b)


This requirement is not met as evidenced by: The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.
Deficient Practice Statement
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Based on observation during the inspection, the licensee did not comply with the section cited by: The indoor and outdoor areas used for the care of children are cluttered and some areas need to be reorganized and repaired. The door of an off limit bedroom needs repair to prevent access by children. The off limit bedroom is not in order. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2023
Plan of Correction
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The licensee will clear the front yard of debris to ensure that children do not have access to hazardous, broken or unclean items. The licensee will repair the door to the off limit bedroom, to prevent access to children. The licensee will proved proof of this by 7/26/23.
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: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Loretta DysonTELEPHONE: 510-695-0243
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2023
LIC809 (FAS) - (06/04)
Page: 6 of 8