013418077-7-14-2021-52-CC-EWOS-C4WMP6-20210714094636

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013418077
Report Date: 07/14/2021
Date Signed: 07/14/2021 09:46:43 AM

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:	POPEJOY, VICTORIA		FACILITY NUMBER:	013418077
ADMINISTRATOR:	POPEJOY, VICTORIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 689-9721
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY:	14	CENSUS: 4	DATE:	07/14/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Chanvanny Seng		TIME COMPLETED:	10:10 AM

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 July 14 , 2021, at 8:00 AM., Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced Annual Required Inspection and met with assistant, Chanvanny Seng. LPA disclosed the purpose of the inspection and was granted entry into the facility by the assistant. Present during the inspection were four (4) children, one (1) school age child, three (3) preschoolers , and two (2) 17 year old helpers. LPA toured the home to conduct a health and safety inspection. The facility plans to operate between the hours of 7:00 AM-7:00 PM, Monday -Friday On-limit-areas are the: Living room, hallway bathroom, family room, day care room, bedroom, kitchen, backyard Off-limit-areas are the: Shed in backyard This single-story home consist of one (1) bedrooms, 1 bath, day care room, family room, kitchen, and backyard, which is neat and clean with heating and ventilation for safety and comfort. The off-limits are will be made inaccessible by closed and/or locked doors and visual supervision. The Isolation area will be the a section of the day care room, away from other children in care. The outdoor play area is the fully fenced backyard and LPA observed that it is free from defects or dangerous conditions. There are ample age appropriate toys that appear to be safe and in good condition. There's a shed in the backyard blocked/with a lock and is off limits to children in care. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today's inspection. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. See 809-Continuation

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

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: POPEJOY, VICTORIA	FACILITY NUMBER: 013418077
	VISIT DATE: 07/14/2021

NARRATIVE

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The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, first aid kit and telephone.

Per licensee, there are no firearms in the home. The licensee is in compliance with the immunization laws which pertains to all childcare providers. The licensee and assistants, CPR and First Aid certificate is current and expires 06/2/2023. The licensee has completed and received a certificate in mandated reporter training on 06/08/21, and her assistant completed hers on 5/26/21. All required forms are posted and visible for public review.

At 9:00 AM LPA requested and reviewed the files of two (2) children in care. All files contained Immunization, Parent's Rights, Identification & Emergency Info, and Medical Consent forms. The facility roster was reviewed, and copies was obtain. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 7/06/2021. The licensee is in ratio today.

Licensee is 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. Licensee was reminded of her/his responsibility as mandated reporter.

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 is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

See Continuation

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

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: POPEJOY, VICTORIA	FACILITY NUMBER: 013418077
	VISIT DATE: 07/14/2021

NARRATIVE

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California Law requires Family Child Cares 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 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail.

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 provided information regarding effects of Lead Exposure and testing requirements (Assembly Bill 2370).

Incidental Medical Services (IMS) policy was discussed. Per licensee, no IMS is being provided at this time. The licensee was reminded that 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.”

There are no deficiencies cited. This report shall remain on file for 3 years. Exit interview was conducted with the licensee. A Notice of Site visit was posted at the time of inspection and must remain posted for 30 days.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

LIC809 (FAS) - (06/04)

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