013418139-1-30-2024-02-CC-JMCN-CZYT3D-20240130132211

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013418139
Report Date: 01/30/2024
Date Signed: 01/30/2024 01:22:25 PM

Document Has Been Signed on 01/30/2024 01:22 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	JULIEN, ANDRE		FACILITY NUMBER:	013418139
ADMINISTRATOR:	JULIEN, ANDRE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 734-7788
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94707
CAPACITY:	14	CENSUS: 9	DATE:	01/30/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Licensee Julien Andre		TIME COMPLETED:	01:30 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 1/30/2024 at 9:05AM Licensing Program Analysts (LPAs) Janai McClain and Indira Loza met with Licensee Andre Julien for an Unannounced Annual Inspection. Present during the inspection were his assistant Collette Julien (Coco), son Jackson Julien, three infants, and six preschoolers. The home was toured for a health and safety inspection. The facility operates from 8:30am – 4:30pm Monday through Friday. The home is a single story house that consists of three bedrooms and two bathrooms. The entrance to the day care is on the right side of the house through the gate to the back area of the house. The inside of the home was observed to be neat and clean with ample age appropriate materials for the children. ON LIMITS AREA: The kitchen, dining room, living room, bathroom to the left of the hallway, and fenced in backyard. OFF LIMITS AREA: The bathroom to the right and all bedrooms. Off limit areas will be made inaccessible by closed and/or locked doors. ISOLATION AREA: The living room and dining room. The home has a fully charged 3A40BC fire extinguisher, a functioning combination smoke and carbon monoxide detector located in the dining room. The Licensee has provided a working telephone number and email address. The CPR and First Aid certificate is current and expires on 06/2025. The mandated reporter certificate expires on 12/21/2024. The fireplace is blocked off with a gate preventing access by children. Per Licensee, there are no firearms in the home. LPAs reviewed staff and children's files which were all complete and current. All required forms are posted and visible for public view. ********************************Report Continues on LIC 809-C*****************************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Janai McClain	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: JULIEN, ANDRE	FACILITY NUMBER: 013418139
	VISIT DATE: 01/30/2024

NARRATIVE

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The fire drill log was available and the last fire drill was conducted on 10/10/2023. The last disaster drill was conducted on 10/26/2023.

Incidental Medical Services (IMS) policy was discussed. The Licensee is not currently providing IMS to the children in care. For IMS information see PIN 22-02. When any IMS is 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

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed on Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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 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. LPA provided the Licensee with the Infant Safe Sleep Regulations.

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. **********************************Report Continues on LIC809-C*******

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Janai McClain	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: JULIEN, ANDRE	FACILITY NUMBER: 013418139
	VISIT DATE: 01/30/2024

NARRATIVE

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During the Exit Interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.

There was 1 Type B deficiency cited during today's visit. See LIC809-D.

Exit interview conducted and report was reviewed with Licensee Andre Julien.
Report and Appeal Rights were provided.
A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Janai McClain	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/30/2024 01:22 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: JULIEN, ANDRE	FACILITY NUMBER: 013418139
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as 3 out of 3 infants did not have a sleep log, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/01/2024
	Plan of Correction
1 2 3 4	Licensee shall keep sleep logs of all napping infants documentating the infants name, date, time of check, and sleeping conditions, including but not limited to, labored breathing, flushed skin color, sweating, or restlessness. The licensee shall email the LPA a copy of 5 consecutive days of sleep logs no later than 03/01/2024.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Janai McClain	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC809 (FAS) - (06/04)

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