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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419881
Report Date: 05/08/2019
Date Signed: 05/08/2019 11:43:18 AM

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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:RAWNER, JUDITHFACILITY NUMBER:
013419881
ADMINISTRATOR:RAWNER, JUDITHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 290-7641
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY:14CENSUS: 13DATE:
05/08/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Judith RawnerTIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst Caroline Colson met with Judith Rawner and her assistants, Christina Secchi and Avivah Paskowitz for an unannounced random annual inspection at 9:45 AM. The home was toured for a health and safety inspection. On child's record was reviewed by the LPA and the licensee on 5/8/19 at 10:32 AM. C1 has immunization records on the California School Immunization Form. There 12 preschool and one school age children present. A review of all required forms was conducted. Mrs. Rawner was informed of the new civil penalty assessments of up to $500 per adult for not having cleared fingerprints on file (if needed) before contact with the day care children.

The home is a one story home. The home consists of a living room, dinning room, kitchen, 3 bedrooms, 2 bathrooms, fenced back yard with a swimming pool, unfenced front yard, chicken coop and garage. The three bedrooms, one bathroom and locked swimming pool are off-limits to the children. The home has a 2A10BC fire extinguisher, a working smoke detector and carbon monoxide detector. The hallway will be used for the isolation area. Mrs. Rawner states there are no firearms in the home. Mrs. Rawner will use her fenced back yard for outdoor play. First Aid Kit is available and complete. Ms. Secchi has current CPR and First Aid and expires on November 2020.

This facility provides Incidental Medical Services-IMS. LPA reviewed the storage of medication and equipment /supplies, and reviewed children and personnel records. LPA discussed the need to create a plan of operation. Specifics on the plan can be found in the family child care home evaluator manual (FCCH EM) Policy 102417.

See LIC 809 C for additional information
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: RAWNER, JUDITH
FACILITY NUMBER: 013419881
VISIT DATE: 05/08/2019
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REMINDERS/RESOURCES

· Criminal Background Clearance: All assistants, volunteers, frequent adult visitors (adults are individuals 18 years of age or older) must be fingerprint cleared and associated to the facility prior to be in the presence of children in care. Failure to comply, requires an immediate civil penalty of $100 to $3000 per person, per incident.

· CCLD Complaint Hotline, 1-844-LET-US-NO (1-844-538-8766) email: LetUsNo@dss.ca.gov

· NEW LAW: Safe Sleep Regulations: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep

· Licensees and all staff are Mandated Reporters and are required to report to CCLD any suspected child abuse.

CCLD website address for obtaining licensing forms, training videos and other provider resources can be obtained at www.ccld.ca.gov

· Licensees may register to receive child care updates: www.myccl.ca.gov

Analyst discussed the children's schedule to ensure ratio compliance.

There are no deficiencies cited during this inspection.
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019
LIC809 (FAS) - (06/04)
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