013419028-10-11-2021-52-CC-LDBX-C7PRTZ-20211011131911

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013419028
Report Date: 10/11/2021
Date Signed: 10/11/2021 01:19:23 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	EVANS, CAROL		FACILITY NUMBER:	013419028
ADMINISTRATOR:	EVANS, CAROL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 600-0108
CITY:	PLEASANTON	STATE: CA	ZIP CODE:	94588
CAPACITY:	14	CENSUS: 9	DATE:	10/11/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Carol Evans		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	October 11, 2021 Licensing Program Analyst, (LPA) Lorraine Dacanay Breaux made an unannounced 1 year required inspection to the facility. Met with Licensee, Carol Evans who was present with her husband, mother, and father all finger print cleared and licensee 17 year old daughter. Three infants, and 5 preschoolers and one school age child was present during the inspection. Hours of Operation are Monday - Friday 7AM-6PM This is a two story home. On Limit Areas: Family room, dining room, first floor bathroom, kitchen, living room, and backyard. OFF Limit Areas: Garage, entire second floor upstairs which includes master bedroom and bathroom, two bedrooms and two bathrooms. The facility had a working smoke detector, carbon monoxide detector, and fully recharged size 2A10BC fire extinguisher. There are no bodies of water such as pools, hot tubs, or similar bodies. Poisons, detergents, cleaning compounds, and medication were inaccessible to children. The fireplace has been blocked off. The home is kept clean and orderly, with heating and ventilation for safety and comfort. A child safety gate was in place at the stairway. The home has safe toys, play equipment, and materials. The Licensee is present in the home and ensures that children are supervised at all times. Licensee was reminded that children are not to be left alone in vehicles. The Licensee maintains the capacity on the license. Each child has safe, comfortable, and healthful accommodations, furnishings, and equipment. Licensee stated there were no guns or weapons in the home. Children's files were reviewed and found to be complete including immunization requirements. The Licensee is conducting and documenting fire drills, infant sleep log in being maintained and utilizing the child care roster.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2021

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: EVANS, CAROL	FACILITY NUMBER: 013419028
	VISIT DATE: 10/11/2021

NARRATIVE
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SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2021

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: EVANS, CAROL	FACILITY NUMBER: 013419028
	VISIT DATE: 10/11/2021

NARRATIVE

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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.

Licensee Carol Evans 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 Carol Evans 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 Carol Evans 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.

Applicant was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. Applicant current CPR/First Aid which expires 11-01-2022. Mandated reporter training was completed on 03/15/2020 and Lead Prevention was completed on 06/15/2021.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Carol Evans

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2021

LIC809 (FAS) - (06/04)

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