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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420306
Report Date: 07/12/2022
Date Signed: 07/12/2022 02:50:21 PM


Document Has Been Signed on 07/12/2022 02:50 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:OLIVARES, NELLYFACILITY NUMBER:
013420306
ADMINISTRATOR:OLIVARES, NELLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 790-9116
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY:14CENSUS: 14DATE:
07/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Nelly Olivares- LicenseeTIME COMPLETED:
03:03 PM
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On 7/12/22 at 1:43pm, Licensing Program Analyst Briana Plumboy, met with licensee Nelly Olivares for an UNANNOUNCED RANDOM INSPECTION. Present for this visit was assistant Maira Ortiz, 1 infant, 8 preschoolers, 5 school age and licensees fingerprint clear husband Carlos Silva. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from Monday through Friday from 6:00am until 5:00pm.

The home is single story. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the room to the right of the entrance (permitted by city of Newark) which has been designed as a play/learning room, the hallway bathroom, the first room located on the left side of the hallway which has been designed as an infant room, the living room, and the dining room. The OFF LIMIT AREAS are the kitchen, master bedroom/bathroom, and the last bedroom located on the right side at the end of the hallway which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be the living room. The BACKYARD play area is fenced. There is a fully enclosed/netted trampoline with a fastened closure. Use of the trampoline requires direct adult supervision present at all times children are present. There is a locked storage inside the backyard which children do not have access to. There are toys. There are 2 anchored play structures in the backyard. Licensee is aware all manufacture instructions must be followed at all times for play equipment. There are no pools, hot tubs or any other bodies of water present during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible to children in care during today's inspection.

The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone, and First Aid Kit. The licensee CPR and First Aid certificate is current and expires 02/18/24, and her assistants is current and expires 06/29/23. The licensee's mandated reporter training is complete and she received a certification of completion on 01/21/22, and her assistant received her certificate on 06/26/21. The licensee and her assistant are in compliance with the immunization law. There are no wall heaters or fireplaces inside the home. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 07/06/22.
See 809-C for continuance
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


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: OLIVARES, NELLY
FACILITY NUMBER: 013420306
VISIT DATE: 07/12/2022
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Incidental Medical Services (IMS) policy was discussed. 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

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, 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 of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov



LPA discussed the safe sleep regulations with licensee Nelly Olivares 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 Nelly Olivares 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.

No deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Nelly Olivares.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022
LIC809 (FAS) - (06/04)
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