013418677-1-16-2020-02-CC-SNEN-BKVT2T-20200116132115

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013418677
Report Date: 01/16/2020
Date Signed: 01/16/2020 01:21:21 PM

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:	FITCH, LISA		FACILITY NUMBER:	013418677
ADMINISTRATOR:	FITCH, LISA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 406-2624
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94609
CAPACITY:	14	CENSUS: 12	DATE:	01/16/2020
TYPE OF VISIT:	Annual/Random	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Lisa Fitch		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	An unannounced Annual/Random site inspection visit was conducted by LPA Susan Neeson. Met with Lisa Fitch, Licensee. Visit began at 10:30. Lisa Fitch is present with 12 preschool age children and her assistant. There are 3 adults fingerprinted and associated with the facility. Lisa Fitch stated that she resides here by herself. The home was inspected for health and safety. The home is the lower floor of a two story condominium. The home consists of a living room, dinning room, kitchen, 2 bedrooms, 1 bathroom, unfenced front yard and fenced back yard. The master bedroom is the off-limit area. The basement and garage are off-limits. All other areas are used for the day care. The bathroom was inspected and contains no hazards. The back yard is used for children and contains a small play house, sand box and gardening area. The home has a 2A10BC fire extinguisher, one working smoke detector and a carbon monoxide detector. There are no pools, spas, hot tubs, fish ponds or similar bodies of water. All poisons, detergents, cleaning compounds and medications are stored in areas which are inaccessible to children. The home has central heating. There is no fireplace. First Aid Kit is available and complete. There are adequate toys and equipment for children in care. Fire and Disaster Drills are conducted every month and documented. She has one small dog as a pet. Records were reviewed. Copy of roster is requested for the file. Lisa Fitch states that there are no guns or firearms in the home or garage or basement. 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 the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov and for day care updates visit www.myccl.ca.gov

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan Neeson	TELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

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: FITCH, LISA	FACILITY NUMBER: 013418677
	VISIT DATE: 01/16/2020

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. According to Lisa Fitch, there are no children currently enrolled that need IMS.

The following items were issued LIC 311A and Safe Sleep for infants information. Other forms requested will be mailed to facility.

No deficiencies are obsrved.

An exit interview was conducted.

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan Neeson	TELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2