013417902-10-20-2022-02-CC-RHAR-CKDSZF-20221020141905

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013417902
Report Date: 10/20/2022
Date Signed: 10/20/2022 02:19:14 PM

Document Has Been Signed on 10/20/2022 02:19 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:	CARPENTER, CAROLYN		FACILITY NUMBER:	013417902
ADMINISTRATOR:	CARPENTER, CAROLYN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 967-2560
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94602
CAPACITY:	14	CENSUS: 6	DATE:	10/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Carrie Carpenter (daughter of licensee)		TIME COMPLETED:	02:30 PM

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On October 20, 2022 at approximately 12:15pm Licensing Program Analysts (LPA) Russ Haderer and Lorraine Dacanay-Breaux arrived unannounced for an annual inspection for health and safety. Present for the inspection were the licensees 2 fingerprint and associated helpers and 6 children in care (2 two-years old and 4 four-years old). The licensee was not at home, the facility is in ratio today. The hours of operation remain at 8:00 to 6:00pm.

The facility is a two-story single-family home with 4 bedroom 2 bathrooms with a front and back yard area, two-car detached garage. There is a child gate blocking access to the stars for the 2 off-limits bedrooms upstairs. There is a fireplace in the living room that is not in use and completely blocked off. There are two pet cats (vaccination papers available) living upstairs that do not leave the off-limits upstairs while the children are present. ISOLATION AREA will be in the on-limits bedroom away from other children in care until their parents can come and pick them up.

On-limit-areas include: Living room, dining room; front bedroom and house bathroom and fenced backyard area. Licensee reminded that other than wipes or things used for the children in the on limits bathroom, they need to be empty of most all items (or locked up) such as cleaning products etc. There were no hazardous items in any drawers or cupboards.

Off-limit-areas include: Upstairs 2 bedrooms and 1 bathroom, kitchen, pantry and basement. The off-limit areas will be inaccessible by closed and/or locked doors. The children are supervised to pass through the kitchen and pantry on the way to the backyard area.

There is a fully charged 3A40BC fire extinguisher in the kitchen. The facility has a working (tested) smoke and carbon monoxide detectors. Per licensee, there are no firearms in the home. The licensee conducts and documents Fire/Disaster Drills, the last drill was done on 10/06/2022. Required licensing documents are posted and visible. Licensee rents the home and does not have liability insurance, signed forms from all parents acknowledging this is in all children’s files.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

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: CARPENTER, CAROLYN	FACILITY NUMBER: 013417902
	VISIT DATE: 10/20/2022

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There were ample age appropriate toys that were observed to be safe and in good condition. The home has heating and ventilation for safety and comfort. LPAs did not observe any hazardous materials, or toxins accessible to children on the premises during the inspection.

Children's files were reviewed, the facility roster was reviewed and a copy obtained. Children’s files were all complete and in good order. Staff files were reviewed and complete.

Licensee and helper’s pediatric CPR/First Aid certificates are all current; licensee’s expires on 2-20-2023, helper’s expire 2-20-2023 and 11-19-2023. Licensee and helper’s Mandated reporter training are all current; licensee’s done May 21, 2021; helpers were done on 6-18-2021 and 11-19-2021. Licensee, and all adults living in the home are in compliance with immunization laws which pertains to day care providers. LPAs reminded the licensee that CPR/1^st Aid and Mandated Reporter training is to be renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

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.

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

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-and-resources/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.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

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: CARPENTER, CAROLYN	FACILITY NUMBER: 013417902
	VISIT DATE: 10/20/2022

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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.

There were no deficiencies issued today.

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

Exit interview conducted and report was reviewed with the licensee’s daughter Carrie Carpenter.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC809 (FAS) - (06/04)

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