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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419574
Report Date: 04/01/2022
Date Signed: 04/01/2022 01:46:00 PM


Document Has Been Signed on 04/01/2022 01:46 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:ALCORN-FERNANDEZ, LYNDAFACILITY NUMBER:
013419574
ADMINISTRATOR:ALCORN-FERNANDEZ, LYNDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 396-2686
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY:14CENSUS: 8DATE:
04/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:58 AM
MET WITH:Lynda Alcord-FernandezTIME COMPLETED:
01:55 PM
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On 4/1/2022, Licensing Program Analyst (LPA) Jonathan Williams arrived at the facility unannounced for the purposes of conducting a Required 1-Year Inspection. LPA was met by Licensee, Lynda Alcorn-Fernandez. Present for today's inspection are the Licensee and eight children in care (four school-aged children and four preschool-aged children). No other individuals were present in the home during today's inspection. Facility operating hours are 7:45am-5:30pm M-F. The facility was toured to conduct a health and safety inspection.

The home is a 1-story home. The ON LIMIT AREAS are the family room, the living/dining room area, the 2 childcare/play rooms located adjacent to the living room, the hallway bathroom, the master bathroom, and backyard. The OFF LIMIT AREAS are the garage and all four bedrooms which will be made inaccessible by closed and/or locked doors and visual supervision. The master bedroom is on limits in order for children to walk through to use the master bathroom in case of emergency. The ISOLATION AREA will be the living/dining room area. Licensee is advised that all areas marked "off-limits" in this report must be inspected by Community Care Licensing representative before it can be used for daycare.

At 12:15pm, LPA toured the facility interior. The home is tidy and clean with heating and ventilation for safety and comfort. There are safe age-appropriate toys and learning materials available to children throughout the home. All hazardous materials and toxins including disinfectants and cleaning solutions were observed to be made inaccessible to children during today's inspection. Furniture accessible to children was observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts. Food/beverages capable of rapid spoiling are properly stored. Uncontaminated drinking water is available to children. There are no firearms kept in the home at this time, per Licensee. Nobody smokes in the home, per Licensee.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 04/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/01/2022
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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Document Has Been Signed on 04/01/2022 01:46 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: ALCORN-FERNANDEZ, LYNDA
FACILITY NUMBER: 013419574

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(d)
Personnel Records
(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on statement made by licensee, the licensee did not comply with the section cited above. Due to rearrangements made in the home in preparation for the house to be painted, all personnel records have been temporarily placed in an inaccesible location. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2022
Plan of Correction
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Licensee shall locate records and make available for LPA to review during in-person visit to be conducted at a later date.
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on statement made by licensee, the licensee did not comply with the section cited above. Due to rearrangements made in the home in preparation for the house to be painted, all child's records have been temporarily placed in an inaccesible location. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2022
Plan of Correction
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Licensee shall locate records and make available for LPA to review during in-person visit to be conducted at a later date.

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: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 04/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/01/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4


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: ALCORN-FERNANDEZ, LYNDA
FACILITY NUMBER: 013419574
VISIT DATE: 04/01/2022
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At 12:26pm, LPA toured the backyard. All play equipment was observed to be operable and age-appropriate during this inspection. The backyard is fenced. There is a dog kept in the backyard. LPA observed the dog to be kept in an area inaccessible to children.

The facility has a fully charged 2A10BC fire extinguisher and working telephone. Carbon monoxide detector and smoke detector are functional (combined). CPR/1st Aid certificate and Mandated Reporter certificate for Licensee are unavailable to view. No files were reviewed for proper documentation because files have been moved to an inaccessible location in the house in preparation for the house to be painted.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS to children in care at this time. 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, 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.

Licensee was reminded that California Law requires licensed Family Child Care Homes 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 624b). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the Licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: ALCORN-FERNANDEZ, LYNDA
FACILITY NUMBER: 013419574
VISIT DATE: 04/01/2022
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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.

Two Type B deficiencies was cited today. A notice of site visit was given and must remain posted for 30 days. Appeal rights were provided to the Licensee and the signature on this form acknowledges receipt of these rights. Exit interview was conducted and report was reviewed with the Licensee.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4