013418122-6-24-2019-02-CC-LDYN-BDFPC8-20190624111131

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013418122
Report Date: 06/24/2019
Date Signed: 06/24/2019 11:11:39 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	SALCEDO, ALBA		FACILITY NUMBER:	013418122
ADMINISTRATOR:	ALBA SALCEDO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 531-7762
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94619
CAPACITY:	14	CENSUS: 6	DATE:	06/24/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:17 AM
MET WITH:	Alba Salcedo		TIME COMPLETED:	11:20 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 6/24/19 at 9:17am Licensing Program Analyst (LPA) Loretta Dyson arrived at the home for an unannounced random inspection. The licensee's fingerprint husband, two fingerprint cleared assistants M. Septien and A. Andaye, 2 infants, and 4 preschool age children were also present. At 9:30am, LPA requested and reviewed the files of 4 children in care. The facility roster was reviewed, and a copy was obtained. LPA reviewed the files of the two assistants and verified that they have the required immunizations and documents. The licensee's CPR/first aid certificates are current and expire on 6/2/2020. At 10:10am, LPA began an inspection of the areas of the home used for the child care. The home is neat and clean with heating and ventilation for the safety and comfort of children in care. The on limit areas include the living room, which has been converted into the child care area, and the hallway bathroom. The kitchen is used for walk thru to the backyard. All other areas of the home are off limits and are made inaccessible by closed and/or locked doors and visual supervision. The isolation area will be a section of the living room, away from other children in care. The outdoor play area is the backyard, which is fully fenced. LPA observed that the backyard is free from defects and dangerous conditions. The small play structures have sufficient cushioning underneath to absorb a fall. LPA observed an ample supply of toys and activities, which are age appropriate and in good condition. LPA did not observe any bodies of water, hazardous items or toxins accessible to children today. There is a fully charged 2A10BC fire extinguisher, working carbon monoxide detector, working smoke detector, first aid kit, and telephone. LPA observed that the fireplace is blocked to prevent access by children. There is a gate at the steps leading up to the bathroom. The licensee stated that there are no firearms in the home. Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to sign up to receive quarterly updates by email by sending a request to ChildCareAdvocatesProgram@dss.ca.gov. The Licensee was given a copy of A Child Care Provider's Guide to Safe Sleep pamphlet and LPA discussed safe sleep practices and policy.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2019

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 2

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: SALCEDO, ALBA	FACILITY NUMBER: 013418122
	VISIT DATE: 06/24/2019

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
26
27
28
29
30
31
32

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. The licensee stated that there are no children enrolled at this time, who require medication while in care.

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. LPA reviewed the individuals associated to the license, and the licensee confirmed that everyone who is required to have a criminal record clearance is associated.
Licensee was reminded of the responsibility as a mandated reporter. The licensee was advised of the required mandated reporter training to be completed as of 1/1/18, at www.mandatedreporterca.com.

There are no deficiencies being cited today. This report shall remain on file for 3 years. A Notice of Site visit was given to Licensee, and Licensee was reminded that it is required to be posted for 30 days. An exit interview was conducted with the licensee.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2