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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419574
Report Date: 04/20/2023
Date Signed: 04/20/2023 01:27:17 PM


Document Has Been Signed on 04/20/2023 01:27 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 SOUTH EAST, 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: 7DATE:
04/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Lynda Alcorn FernandezTIME COMPLETED:
01:41 PM
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On 4/20/2023 at 10:55 am Licensing Program analyst (LPA) Michael Mathew Conducted an unannounced annual visit LPA met with Licensee Lynda Alcorn-Fernandez and discussed the purpose of the Visit. Prior to entering the home LPA conducted Covid-19 screening questions. Licensee and LPA toured inside and out of the home. At the time of the visit there were 7 children and 2 adults. There are age-appropriate toys and equipment for children in care.

Licensee uses the living room, classroom, hallway bathroom, and backyard for the day-care. Licensee stated that there are no guns/weapons or ammunition in the home. LPA observed the knifes are kept on kitchen counter next to the stove inaccessible to children in care. LPA observed chemicals and toxins are kept in a box locked under the sink and inaccessible to children in care. Backyard is fully fenced in and have ample number of toys and equipment for children in care. LPA observed no bodies of water during inspection. There is also a dog which in the side yard away from children, licensee states that the dog does not interact with the children. LPA observed a 2A10BC fire extinguisher present. Fire alarm and carbon monoxide detector are good and in working condition. Licensees CPR/first aid is current and is valid until 1/15/24. Licensee presents have current mandated reporter training valid until 4/27/24. LPA observed assistant did not have a mandated reporter training certificate. Fire drill was conducted on 1/9/23.

The facility is currently providing Incidental Medical Services. LPA observed IMS is kept in the child’s backpack away from the child and kept in an area off limit to the children. LPA observed correct licensing form in child's file. 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

Cont 809-C

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: 510-292-8297
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2023
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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ALCORN-FERNANDEZ, LYNDA
FACILITY NUMBER: 013419574
VISIT DATE: 04/20/2023
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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.

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 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.

A notice of site visit was given and must remain posted for 30 days

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee.

2 Type B deficiencies was cited in today’s visit.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: 510-292-8297
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/20/2023 01:27 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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care.LPA observed assistant did not have an mandated reporter training certificate. License assumed that assistant did not need it since licensee has a completed mandated reporter.
POC Due Date: 04/27/2023
Plan of Correction
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Licensee agreed to send completed assistance's Mandated report training certificate to LPA via email or text by end of day Thursday 4/27/23
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care. LPA observed that Licensees assistant did not have immunization on file. Licensee stated that she just forgot about it.
POC Due Date: 05/04/2023
Plan of Correction
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Licensee agreed to send assistance's immunization to LPA via email or text by end of day Friday 5/5/2023.
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) 421-1324
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: 510-292-8297
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2023
LIC809 (FAS) - (06/04)
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