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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421000
Report Date: 07/10/2019
Date Signed: 07/10/2019 02:34:29 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:HEARNE, KARENFACILITY NUMBER:
013421000
ADMINISTRATOR:HEARNE, KARENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 434-1080
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY:14CENSUS: 12DATE:
07/10/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Karen HearneTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst Caroline Colson met with Karen Hearne for an unannounced case management inspection at 9:45 AM. There are two (2) infants and ten (10) preschool children. Mirna Calderon-Rabago arrived during the inspection.

Please See LIC 809 D for deficiency
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019
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: HEARNE, KAREN
FACILITY NUMBER: 013421000
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/10/2019
Section Cited
CCR
102416.5e
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Staffing Ratio and Capacity
If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

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By POC Date, Licensee will ensure that an assistant is always present on time or reduce the number of children to the ratios of a small family day care home.
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This requirement was not met as evidenced by document review and licensee interview. Licensee was alone while her assistant was on her way to the facility. This poses an potential health risk to the health and safety of children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are 250.00 per violation and $100 per day until corrected.
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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: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019
LIC809 (FAS) - (06/04)
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