013416911-3-14-2022-02-CC-ASIH-CCHQHA-20220314121048

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013416911
Report Date: 03/10/2022
Date Signed: 03/14/2022 12:11:14 PM

Document Has Been Signed on 03/14/2022 12:11 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:	FAGEL, IVETTE		FACILITY NUMBER:	013416911
ADMINISTRATOR:	FAGEL, IVETTE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 865-1750
CITY:	ALAMEDA	STATE: CA	ZIP CODE:	94501
CAPACITY:	14	CENSUS: 5	DATE:	03/10/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Fagel Ivette		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 3/10/2022 Licensing Program Analyst (LPA) Arminder Singh met with Licensee, Fagel Ivette for an unannounced random annual inspection at 08:00AM. LPA arrived when children were engaged in various activities. There are 5 children present today. Records of three children (C1-C3) were reviewed and are complete. The home was toured to conduct a health and safety inspection. Days and hours of operation are Mon - Fri, 7:30 AM to 5:00 PM. At 11:00 AM the home was toured to conduct a health and safety inspection. The home is a two story home. The home consists of a living room, family room, dinning room, kitchen, 3 bedrooms, 2.5 bathrooms, attic, basement, garage, unfenced front yard, fenced back yard which includes a shed(locked) and patio area. The ON LIMIT are the living room, dining room, and kitchen. The OFF LIMITS areas are the unfenced front yard, first bedroom close to the entrance of home, basement, the entire second floor which includes the attic and bedroom. OFF LIMITS which will be inaccessible by closed and or/locked doors and visual supervision. There are ample age appropriate toys that appear to be safe and in good condition. Licensee takes the children to the neighborhood park for outdoor play. There are no pools, hot tubs, or any other bodies of water. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, and carbon monoxide detector. There is centralized heating that is working and in good repair. Licensee states there are no firearms in the home. Licensee does have two pet dogs. The family room is the isolation room. She has a first aid kit. There is centralized heating that is working and in good repair. Licensee states there are no firearms in the home. The bedroom #1 will be used as the isolation room. Licensee does not have pets. Licensee conducts fire/disaster drills every six months. LPA reminded Licensee that the mandated reporter training certificates are to be renewed every two years.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022

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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: FAGEL, IVETTE	FACILITY NUMBER: 013416911
	VISIT DATE: 03/10/2022

NARRATIVE

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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

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.

Licensees 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.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022

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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: FAGEL, IVETTE	FACILITY NUMBER: 013416911
	VISIT DATE: 03/10/2022

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LPA discussed the safe sleep regulations with licensees and discussed the Child Care Licensing Safe Sleep webpage 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.

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

There were no deficiencies in today's visit.

Exit interview was conducted and report was reviewed with the Licensee, Fagel Ivette

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022

LIC809 (FAS) - (06/04)

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