013419837-3-6-2020-52-CC-JWIS-BMFQSL-20200306112543

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013419837
Report Date: 03/06/2020
Date Signed: 03/06/2020 11:25:54 AM

COMPREHENSIVE INSPECTION

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:	WINDHAM, TRACEY		FACILITY NUMBER:	013419837
ADMINISTRATOR:	WINDHAM, TRACEY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 938-5060
CITY:	NEWARK	STATE: CA	ZIP CODE:	94560
CAPACITY:	14	CENSUS: 8	DATE:	03/06/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Licensee - Tracey Windham		TIME COMPLETED:	11:35 AM

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 3/6/2020, Licensing Program Analyst (LPA) Jonathan Williams met with Licensee, Tracey Windham, for a Required 1 Year Inspection. Present for this inspection are eight children in care (one infant and seven preschoolers), the Licensee, and two fingerprint cleared and associated assistant providers. The facility was toured to conduct a Health and Safety Inspection at 9:00am. The home is a one story home and is tidy and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the nap room (1st bedroom on the left side of the hallway), living room, dining room, kitchen, backyard, and hallway bathroom. The OFF LIMIT AREAS are the master bedroom with bathroom, son's room, and garage, all of which will be made inaccessible to children by closed and/or locked doors and visual supervision. The ISOLATION ROOM will be the living room. The backyard is fenced. There are toys and learning materials in the facility. There is a hot tub in the backyard which LPA observed at 9:34am to be made inaccessible to children via securely locked cover. All hazardous materials and toxins were observed to be made inaccessible to children during today's inspection. Per Licensee, there are no firearms kept in the home. There is a fireplace in the home which LPA observed at 9:45am to be screened to prevent access to children. LPA observed at 9:50am that the facility has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Licensee has current CPR/1st Aid training which expires on 1/2021. Mandated Reporter Training for Licensee expires on 3/15/2020. The facility is in ratio today. Children's files and staff files were reviewed for proper documentation at 10:00am. Facility roster was obtained at 11:15am.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

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: WINDHAM, TRACEY	FACILITY NUMBER: 013419837
	VISIT DATE: 03/06/2020

NARRATIVE

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Individual Medical Services (IMS) policy was discussed. This facility does not provide IMS at this time. Licensee was advised that if IMS is provided at a licensed Family Child Care Home, 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 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 that California Law requires licensed Family Child Care Home licensees 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 624). 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.

There are no deficiencies cited. This report shall remain on file for 3 years. A Notice of Site Visit was provided to the Licensee. LPA reminded the Licensee to post the Notice of Site Visit where it is clearly visible inside the facility for 30 days. Appeal rights were provided to the Licensee. Exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

LIC809 (FAS) - (06/04)

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