013420387-1-17-2020-02-CC-BNEN-BKWV3Q-20200117150507

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013420387
Report Date: 01/17/2020
Date Signed: 01/17/2020 03:05:16 PM

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	GONZALEZ, MARIA		FACILITY NUMBER:	013420387
ADMINISTRATOR:	GONZALEZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 356-4474
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94702
CAPACITY:	14	CENSUS: 10	DATE:	01/17/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Maria Gonzalez		TIME COMPLETED:	04:15 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 01/17/2020, Licensing Program Analyst (LPA) Brittany Newton made an unannounced visit for the purpose of conducting a required annual inspection. LPA was met by licensee Maria Gonzalez. Present for this visit was 3 infants, 6 preschoolers, and one school aged child. Additionally present was the licensees husband and assistant. The home was toured to conduct a health and safety inspection. The home is a two story home. The home consists of a living room, dinning room, 2 upstairs bedrooms, kitchen, 2 downstairs bedrooms, 1 upstairs bathroom, 1 downstairs bathroom, fenced back yard, fenced front yard. The 2 downstairs bedrooms, 1 downstairs bathroom, dinning room, kitchen and shed are the off-limits areas. Licensee states that there are no firearms. The isolation area is the first bedroom. There are no pools, spas, hot tubs, fish ponds or similar bodies of water. All poisons, detergents, and cleaning compounds are stored in areas which are inaccessible to children. There are no fireplaces or open face heaters accessible to children. The home has a 2A10BC fire extinguisher, smoke detector and carbon monoxide detector. The home is clean and orderly with heating and ventilation. There is a gate which is to prevent children from accessing the kitchen. Licensee provides children with snacks and meals. Food was inspected and found in compliance. Ample age appropriate toys were observed and available for children. Fire and Disaster Drills are conducted with the last one being 10/2019. Licensee takes the children to the neighborhood park for outdoor play. Pediatric CPR and First Aid certificates are current and expire on 04/13/2021. LPA Newton reviewed children’s records which were found in compliance. LPA Newton reminded licensees children can not sleep in strollers or car seats. A guide to safe sleep pamphlet was given and the importance of taking preventative measures was discussed. 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.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Brittany Newton	TELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GONZALEZ, MARIA	FACILITY NUMBER: 013420387
	VISIT DATE: 01/17/2020

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Licensee is 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 of the responsibility as a mandated reporter.

Licensee will email LPA Newton the child care roster because one page was missing.

No deficiencies observed at this visit. A Notice of Site visit was given and licensee was reminded that it is required to be posted for 30 days. Exit interview conducted, appeal rights provided, and a copy of this report was left with Maria Gonzalez.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Brittany Newton	TELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020

LIC809 (FAS) - (06/04)

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