013418033-2-10-2020-52-CC-EWOS-BLNTLE-20200210134925

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013418033
Report Date: 02/10/2020
Date Signed: 02/10/2020 01:49:31 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:	SOWUNMI, HORTENSIA		FACILITY NUMBER:	013418033
ADMINISTRATOR:	SOWUNMI, HORTENSIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 889-8499
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY:	14	CENSUS: 7	DATE:	02/10/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Hortensia Sowunmi		TIME COMPLETED:	02:20 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 02/10/2020, at approximately 11:05 AM, Licensing Program Analyst Elimika Woods (LPA) met with licensee Hortensia Sonwunmi for the purpose of an unannounced 1 YR required visit. Present for this visit was six preschool age children, one infant, and the licensee’s fingerprint clear assistant Rachel Roberts. Also present during the inspection was licensee's mother, Marie De Campos who was visiting from Dakar, Africa. The home was toured to conduct a Health and Safety Inspection. The facility currently plans to operate 7:00 AM until 6:00 PM., Monday through Friday On-limit-areas include: Living room, dining area, family room, backyard, and converted garage Off-limit-areas include: Kitchen, entire second level of home The home is two story, which consists of four bedrooms, two baths, kitchen, living and dining room, family room, and backyard. The home is neat and clean with heating and ventilation for safety and comfort. The off- limits area is made inaccessible by closed and/ or locked doors and visual supervision. There's a gate at the bottom of the stairs to prevent children 5 years of age access. The ISOLATION AREA will be the living room away from children in care. The outdoor play area is fenced and is free from defects and dangerous conditions. The right side of the yard has a swing, which is anchored to the ground and has rubber pads for safety. LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during today inspection. There are ample age appropriate toys, learning materials, and equipment that appear to be safe and in good condition. The home has a fully charge 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone and First Aid Kit. The licensee’s Health and Safety training is completed, and CPR and First Aid certificate is current and expires 04/09/2021. The licensee completed and received a certificate in mandated reporter training on 11/12/2018. Her assistant has a certificate of completion for the required mandated reporter training, dated 03/18/19, and her CPR/first aid certificate expires on 09/28/20. See 809-C for continuance

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2020

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: SOWUNMI, HORTENSIA	FACILITY NUMBER: 013418033
	VISIT DATE: 02/10/2020

NARRATIVE

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The licensee conducts and documents fire and disaster drills at least twice a year, and the log indicates a drill was conducted 01/10/2020. The facility roster was reviewed, and a copy obtained. The fireplace is blocked to prevent access by children.

At 12:00 PM, LPA Woods requested to review three (3) children’s facility files. Each file contained completed Identification & Emergency forms, Medical consent forms, and Personal Right's.

Incidental Medical Services (IMS) -Per the licensee, there are no children on any form of medication. The licensee is not providing IMS currently.

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 discussed Unusual Incidents Reports.

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

The licensee was 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. The licensee was reminded of the responsibility as a mandated reporter.

The licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The licensee was given a copy of A Child Care Provider's Guide to Safe Sleep pamphlet.

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2020

LIC809 (FAS) - (06/04)

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