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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418039
Report Date: 06/13/2023
Date Signed: 06/13/2023 02:11:28 PM


Document Has Been Signed on 06/13/2023 02:11 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:COLON-PRICE, CARMEN, & BIELEFELDT, CARMENFACILITY NUMBER:
013418039
ADMINISTRATOR:COLON-PRICE, CARMENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 530-3276
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY:14CENSUS: 9DATE:
06/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Carmen Colon-Price/Carmen BielefeldtTIME COMPLETED:
02:40 PM
NARRATIVE
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On June 13, 2022 at approximately 12:00pm, Licensing Program Analyst (LPA) Lorraine Dacanay Breaux met with licensees, Carmen Colon-Price and Carmen Bielefeldt for an unannounced 1-year required annual visit. During today's inspection was fingerprint cleared husband for C. Bielefeldt. There are four (4) infants and eight (8) preschool children present. The home was toured inside and outside to conduct a health and safety inspection. Hours of operation are Monday - Friday, 7:30AM - 5:30PM.

The home is a two story home. The home consists of a living room, dinning room, kitchen, 3 bedrooms, 2 bathrooms, laundry area, front yard and fully fenced back yard and garage.

ON LIMIT AREAS: Living room, dining-room, small bedroom at the rear of the home, on the left near that back yard door (infant only use per licensee), bathroom next to the laundry room.

OFF LIMITS AREAS: The two bedrooms, one bathroom, rear/back section of the back yard, laundry room (only used for travel purposes to the bathroom). ISOLATION AREA: Living room away from the children in care until parents pick up.

The off-limits are will be made inaccessible by closed and/or locked doors and visual supervision. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today's inspection.


The home has a 3A40BC fire extinguisher and one working smoke alarm and a carbon monoxide detector (tested). Licensee states that there are no firearms in the home. Fully stocked First Aid Kit is available. Both licensees CPR and First Aid certificates both current and expires on 04/2025.

See 809-C for continuance

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-BreauxTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2023
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 9


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: COLON-PRICE, CARMEN, & BIELEFELDT, CARMEN
FACILITY NUMBER: 013418039
VISIT DATE: 06/13/2023
NARRATIVE
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At 12:30 PM, LPA requested and reviewed the files of six (6) children in care. All children files were found incomplete (medical consent form/insurance) LPA discussed files and provided LIC forms that are required to be within a child's file. The facility roster was reviewed, and copies were obtain.Per licensee did not have or document fire drill. The licensee's Health and Safety training is completed, and CPR and First Aid certificate is current and expires 04/2025.

The OUTDOOR PLAY area is the fully fenced backyard and LPA observed that it is free from defects or dangerous conditions. The yard has trees for shade. During today's inspection, there are no play structures which are required to be anchored. There are age appropriate toys that appear to be safe and in good condition.

Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

Individual Medical Services (IMS) policy was discussed. This facility provides IMS to children in care. Facility is following IMS plan on file. When any changes to the IMS plan is made, an updated 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.”


See-809 C
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-BreauxTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
LIC809 (FAS) - (06/04)
Page: 2 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: COLON-PRICE, CARMEN, & BIELEFELDT, CARMEN
FACILITY NUMBER: 013418039
VISIT DATE: 06/13/2023
NARRATIVE
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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.

Licensees are reminded that all jumpers, swings, drop down cribs, baby bouncers, and similar equipment are not allowed in a family day care home.

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.

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.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights provided. Exit interview conducted and report was reviewed with the licensees, Carmen Colon-Price and Carmen Bielefeldt.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-BreauxTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
LIC809 (FAS) - (06/04)
Page: 3 of 9
Document Has Been Signed on 06/13/2023 02:11 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: COLON-PRICE, CARMEN, & BIELEFELDT, CARMEN
FACILITY NUMBER: 013418039

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/13/2023
Plan of Correction
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Effective 06/13/2023 licensee will conduct a drill at leasat twice a year. per Licensee will coduct a drill by Friday, June 16, 2023 and document.
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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-BreauxTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2023
LIC809 (FAS) - (06/04)
Page: 4 of 9