013419837-6-7-2021-52-CC-JWIS-C3RTY7-20210607150817

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013419837
Report Date: 06/07/2021
Date Signed: 06/07/2021 03:08:25 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:	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:	06/07/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:08 PM
MET WITH:	Tracey Windham		TIME COMPLETED:	03:25 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	On 06/07/2021 at 1:08pm, Licensing Program Analyst (LPA) Jonathan Williams met with Licensee, Tracey Windham, for a Required 1 Year Inspection. Present for this inspection are the Licensee, one fingerprint cleared and associated assistant, and eight children in care (four school age and four preschool-age). The facility was toured to conduct a Health and Safety Inspection. The home is a 1 story home rented by the Licensee and is tidy and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are kitchen, dining room, play area, living room, bedroom located across the hallway from the master bedroom, bathroom not located in the master bedroom, and backyard. The OFF LIMIT AREAS are the garage, master bedroom, and bedroom located at the end of the hallway to the left, all of which are made inaccessible to children by closed and/or locked doors and visual supervision. The ISOLATION ROOM is the living room. The backyard is fenced. LPA observed there to be ample toys and learning materials in the facility at approximately 1:30pm. There is a hot tub located in the backyard, and LPA observed it to be covered at 1:45pm. All hazardous materials and toxins were observed to be made inaccessible to children throughout today's inspection. Per Licensee statement at 2:00pm, there are no firearms kept in the home. LPA observed a fireplace in the home at 2:05pm which was screened to prevent access to children at the time of this inspection. The facility has a fully charged 3A40BC fire extinguisher and working telephone. Licensee has current CPR/1st Aid training which expires on 02/2023. Mandated Reporter Training for Licensee expires on 03/07/2023. Mandated Reporter training for assistant provider expires on 3/26/2022. The facility is in ratio today. Children's files were reviewed at 2:12pm for proper documentation. Facility roster was obtained at 2:20pm. Licensee conducts fire/disaster drills at least once every six months.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021

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: WINDHAM, TRACEY	FACILITY NUMBER: 013419837
	VISIT DATE: 06/07/2021

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS 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 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 at 3:03pm.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021

LIC809 (FAS) - (06/04)

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