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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420326
Report Date: 08/29/2022
Date Signed: 08/29/2022 11:32:45 AM


Document Has Been Signed on 08/29/2022 11:32 AM - 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, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:LAUTI, SOANAFACILITY NUMBER:
013420326
ADMINISTRATOR:LAUTI, SOANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 967-3558
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY:14CENSUS: 6DATE:
08/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Soana LautiTIME COMPLETED:
11:45 AM
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On August 29, 2022 at 8:55 AM, Licensing Program Analyst (LPA) Elimika Woods arrived at the home for an unannounced 1 Year Required Inspection. LPA Woods met with the licensee Soana Lauti, fingerprint cleared husband T. Lauti, Grandmother, L. Lauti, son K. Lauti, and assistant P. Finck. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. There were five (5) preschool age children and one (1) infant present during the inspection. Licensee stated that the facility operates from Monday to Friday 7:00 AM to 6:00 PM.

LPA toured the facility to conduct a Health and Safety inspection. This two single story home was clean and orderly, with heating and ventilation for the safety and comfort. The Isolation area will be a section of the living room, away from other children in care. There's a detached apartment which belongs to the licensee but it has a different address.

On- Limit areas are the: Living and dining room, Play room next to kitchen, bathroom, backyard, bedroom (2) on the right side of hallway

Off- Limit areas are the: Entire second level of home, kitchen. garage, In-law unit in backyard, and bedroom (1) on the left side of hallway

The off-limits are will be made inaccessible by closed and/or locked doors and visual supervision. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today's inspection. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. There's a gate at the top and bottom of the stairs to prevent children access to the upper level of home and gates in the kitchen. The kitchen is used for a walk through to get in the playroom. There are ample age appropriate toys that appear to be safe and in good condition.

See 809-C
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 622-2550
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2022
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: LAUTI, SOANA
FACILITY NUMBER: 013420326
VISIT DATE: 08/29/2022
NARRATIVE
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The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and telephone. There’s a fireplace in the living with a barricade to prevent access by children and there are floor heaters that are covered in the dining room and bathroom. Per licensee, there are no firearms in the home. All required forms are posted and visible for public review.

At 9:30 AM LPA requested and reviewed the files of three (3) children in care. Each file contain Identification & Emergency information, Medical Consent forms, and Parents Rights. The facility roster was reviewed, and copies were obtain. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 03/29/22. The licensee is in ratio today. The licensee and assistant has not completed or received a certificate in mandated reporter training and the licensee's CPR and First Aid certificate is currently expired.

The following deficiencies were observed during today's inspection: FCCH


· At 10:10 AM, LPA observed that the licensee has not renewed her CPR & first aid certificate.
  • At 10:30 AM , LPA reviewed staff records and did not see Immunization Records.

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 is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

Roster of the children must be properly maintained and fire/disaster drill every six months must be documented. The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. The licensee was provided information regarding effects of Lead Exposure and testing requirements (Assembly Bill 2370).



California Law requires Family Child Cares Homes 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.

See 809-C

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 622-2550
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: LAUTI, SOANA
FACILITY NUMBER: 013420326
VISIT DATE: 08/29/2022
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 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

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.

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.

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.

See 809-d for deficiency cited. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee , Soana Lauti.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 622-2550
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 08/29/2022 11:32 AM - 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: LAUTI, SOANA
FACILITY NUMBER: 013420326

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/29/2022
Plan of Correction
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Licensee shall renew that CPR and First Aid card by 9/29/22. Proof shall be mailed, faxed, or emailed to the LPA.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/12/2022
Plan of Correction
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Licensee shall provide immunization record of staff by 9/12/2022. Proof shall be mailed, faxed, or emailed to the LPA.

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: Chandra CharlesTELEPHONE: (510) 622-2550
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5