013420722-3-2-2020-52-CC-JCHN-BMBSF9-20200302124958

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013420722
Report Date: 03/02/2020
Date Signed: 03/02/2020 12:50:06 PM

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:	SMITH, SYDNEY		FACILITY NUMBER:	013420722
ADMINISTRATOR:	SMITH, SYDNEY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 200-9486
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94545
CAPACITY:	14	CENSUS: 4	DATE:	03/02/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Sydney Smith		TIME COMPLETED:	01:10 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 3/2/2020 at 11:15AM, Licensing Program Analyst (LPA) Junell Chen arrived for an unannounced Required - 1 Year Inspection and met with Licensee Sydney Smith. Present were one (1) infant and three (3) preschoolers in care today. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday 7:30AM-5:30PM. ON LIMITS: The living room, dining room, kitchen, first bedroom on the right of hallway, hallway bathroom, bedroom at the end of hallway, and bathroom inside bedroom at end of hallway, and fenced backyard. OFF LIMITS: The second bedroom on right side of hallway, and garage. Off limit areas are inaccessible by closed and/or locked doors and visual supervision. Licensee is aware she must contact Licensing, so that an inspection can be completed prior to changing an off limits area to on limits. The home is a one-story home, which are neat and clean, with heating and ventilation for safety and comfort. The isolation area will be in the living room. There were ample age appropriate toys that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection. *See LIC 809C for Continuance*

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Junell Chen	TELEPHONE: (510) 622-4035
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2020

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: SMITH, SYDNEY	FACILITY NUMBER: 013420722
	VISIT DATE: 03/02/2020

NARRATIVE

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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 encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

There were no deficiencies being cited during the time of inspection today.

This report has been read to the Licensee in its entirety. An exit interview was conducted with the Licensee. A copy of this report and appeal rights were discussed and left with Licensee, Sydney Smith, whose signature on this form confirm receipt of these documents. LPA asked Licensee if she had any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given to her, and per Licensee, she does not have any questions.

This report shall remain on file for 3 years. A Notice of Site visit was given at time of inspection and requested Licensee to post the Notice in an unobstructed, viewable public area for 30 days.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Junell Chen	TELEPHONE: (510) 622-4035
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2020

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: SMITH, SYDNEY	FACILITY NUMBER: 013420722
	VISIT DATE: 03/02/2020

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A fully charged 3A40BC fire extinguisher, smoke and carbon monoxide detectors exist at the facility and meet State Fire Marshall standards. The fireplace is screened to prevent access by children. There exists a hot tub in the backyard with a functioning cover and is fenced to prevent access by children in care. There exists a First Aid kit readily available at the facility. Knives, sharp objects, chemicals, and cleaning solutions are out of reach of children in care during time of inspection. Knives and sharp objects are stored in the overhead compartments of the kitchen cabinets. The chemicals and cleaning solutions are stored in the the locked lower cabinets of the kitchen that are out of reach of children.

There exist wall heaters and is unreachable and inaccessible by children in care as observed by LPA during inspection today. Per licensee, there exists a firearm locked in the off-limits area and the ammunition is stored separately in an off-limits area in the home. There are two (2) pet dogs in the home. Per licensee, there exists a working telephone number designated for the facility. All required licensing documents are posted and visible for public review. Mandated Reporter training was completed on 3/25/2018 for Sydney Smith. Licensee presented proof of immunization records as required by licensing. Safe Sleep practices and New Car Seat Laws were discussed and a copy provided. Licensee was reminded that children are never to be left in a parked vehicle.

At around 11:50AM-12:30PM, review of documents pertaining to licensing regulations and requirements were conducted. Four (4) children's files were reviewed. The facility roster was presented, and a copy obtained. The Licensee is in ratio today. The licensee's Pediatric CPR/First Aid certificate is current and expires 1/31/2021 for Sydney Smith. Last disaster drill was logged on 1/6/2020.

Individual Medical Services (IMS) policy was discussed. Per licensee, she is not providing IMS at this time. 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.

***See LIC 809C for Continuance***

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Junell Chen	TELEPHONE: (510) 622-4035
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2020

LIC809 (FAS) - (06/04)

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