<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420502
Report Date: 01/15/2020
Date Signed: 01/15/2020 04:38:02 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:STOLL, DAINELLEEFACILITY NUMBER:
013420502
ADMINISTRATOR:STOLL, DAINELLEEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 484-1403
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY:14CENSUS: 3DATE:
01/15/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Dainellee StollTIME COMPLETED:
04:50 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 01/15/2020, Licensing Program Analysts (LPAs) Melanie Otsuji and Jonathan Williams met with Licensee Dainellee Stoll and assistant provider Ruth Galsim for an UNANNOUNCED REQUIRED ONE-YEAR INSPECTION. Present for this inspection are three preschoolers and two providers. The facility was toured to conduct a Health and Safety Inspection.

The home is a one story home and is tidy and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the living room, formal dining room, garage, family room, backyard, first bathroom to the left in the hallway, and the bedroom directly across the hallway bathroom. The OFF LIMIT AREAS are the three remaining bedrooms, all of which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA is the living room. The backyard is fenced. There are toys and learning materials in the facility. There are no pools, hot tubs, ponds, or any other bodies of water in the on-limits areas during this inspection.

The facility has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee and assistant provider have current CPR and first aid certificates as well as current immunizations. The fireplace is screened to prevent access by children. Per assistant, there are no firearms in the home. The licensee conducts and documents fire and disaster drills at least every six months.

Photo copy of facility roster was obtained. The facility is in ratio today.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
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: STOLL, DAINELLEE
FACILITY NUMBER: 013420502
VISIT DATE: 01/15/2020
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
26
27
28
29
30
31
32
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 fingerprinted, obtain a criminal record clearance, and be associated to this facility prior to being in the presence of children in care. Licensee was reminded that any failure to comply with these regulations will result in an immediate assessment of civil penalties of $100 to $3000 per person, per incident. Licensee was reminded of her responsibilities as a mandated reporter. Licensee was directed to the following online resources where CCLD forms can be downloaded: www.ccld.ca.gov.

Incidental Medical Services (IMS) policy was discussed. Licensee was reminded that 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 and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

There are no deficiencies cited. This report shall remain on file for 3 years. A Notice of Site Visit was provided to the Licensee and LPAs Williams and Otsuji reminded the Licensee to post the Notice of Site Visit where it is clearly visible inside the facility for 30 days. Exit interview was conducted.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2