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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418139
Report Date: 06/17/2022
Date Signed: 06/17/2022 11:15:30 AM


Document Has Been Signed on 06/17/2022 11:15 AM - 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:JULIEN, ANDREFACILITY NUMBER:
013418139
ADMINISTRATOR:JULIEN, ANDREFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 734-7788
CITY:BERKELEYSTATE: CAZIP CODE:
94707
CAPACITY:14CENSUS: 6DATE:
06/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:37 AM
MET WITH:Andre JulienTIME COMPLETED:
11:25 AM
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On June 17, 2022 Licensing Program Analyst (LPA) Indira Loza arrived at the facility to conduct an annual random inspection. LPA met with Licensee Andre Julien, Present for the inspection were the Licensee, the Licensee's Adult daughter who is also his Assistant, Licensee's adult son, and six preschool children. The daycare's operation hours are Monday through Friday 8:30am-4pm.

The home is a one story single family home which is neat and clean with heating and ventilation for safety and comfort. The home consists of three bedrooms and two bathrooms and a fully fenced in backyard.. The OFF LIMIT areas are the two bedrooms to the left of the living room, and the bedroom and bathroom to the left of the dining room. The ON LIMIT AREAS are the living room, kitchen, dining room, and the entire backyard. The outdoor play area is a fenced backyard, which is free from defects or dangerous conditions. There are ample age appropriate toys that are safe and appear to be clean and in good repair. There is a hot tub with a cover for safety. LPA did not observe any hazardous materials or toxins accessible to children today. Lunch and snacks are brought from home. The home has a fully charged 3A1040BC fire extinguisher, and a working combined smoke and carbon monoxide detector.
The Licensee’s Pediatric CPR and First Aid training has been completed and expires April 2023. LPA obtained the children’s files for review and the children's roster.

Licensee was reminded that California Law requires Licensee 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 email. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com.

Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months
********************************Report continues on 809-C*****************************
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2022
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: JULIEN, ANDRE
FACILITY NUMBER: 013418139
VISIT DATE: 06/17/2022
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and documented. The Licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Licensee was advised to sign up for Provider Information Notices (PINs) at https://www.cdss.ca.gov/inforesources/community-care-licensing/policy/provider-information-notices/child-care

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02 CCP. 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.

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/process.
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.
LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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
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.
A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Andre Julien.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
LIC809 (FAS) - (06/04)
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