013421000-10-2-2019-02-CC-CCON-BGKSBS-20191002134424

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421000
Report Date: 10/02/2019
Date Signed: 10/02/2019 01:44:29 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, KAREN		FACILITY NUMBER:	013421000
ADMINISTRATOR:	HEARNE, KAREN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 434-1080
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94602
CAPACITY:	14	CENSUS: 7	DATE:	10/02/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:46 AM
MET WITH:	Karen Hearne		TIME COMPLETED:	02:05 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	Licensing Program Analyst Caroline Colson met with Karen Hearne and Brianna Bryant, her assistant for an unannounced random annual inspection at 9:46 AM. There two (2) infants and five (5) preschool children present. The home was toured to conduct a health and safety inspection. One (1) child's record was reviewed by the LPA and the licensee on 10/02/19 at 11:23 AM. C1 has immunization records available in the file. The child's file is complete. The home was toured to conduct a health and safety inspection. The home is a one story home. The home consists of a living room, kitchen, 2 bedrooms, 1 quiet room, 1 bathroom, fenced front yard, fenced back yard and double car garage. The kitchen and quiet room are the off limit areas. The home has a 3A40BC fire extinguisher, one working combination smoke and carbon monoxide detector. Ms. Hearne states that there are no firearms in home. The isolation area is the first bedroom. First Aid Kit is available and complete. The backyard is fenced and will be used for outdoor play. There are two dogs. She has current Pediatric CPR and First Aid certificates which both expire on August 31, 2021. A roster was available and complete. This facility is not providing Incidental Medical Services - IMS at this time. LPA discussed IMS services and the requirement to create a plan of operation. Specifics on the plan can be found in the family child care home evaluator manual (FCCH EM) Policy 102417. Please See LIC 809 C for additional information

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

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
	VISIT DATE: 10/02/2019

NARRATIVE

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REMINDERS/RESOURCES

· Criminal Background Clearance: All assistants, volunteers, frequent adult visitors (adults are individuals 18 years of age or older) must be fingerprint cleared and associated to the facility prior to be in the presence of children in care. Failure to comply, requires an immediate civil penalty of $100 to $3000 per person, per incident.

· CCLD Complaint Hotline, 1-844-LET-US-NO (1-844-538-8766) email: LetUsNo@dss.ca.gov

· NEW LAW: Safe Sleep Regulations: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep

· Licensees and all staff are Mandated Reporters and are required to report to CCLD any suspected child abuse.

CCLD website address for obtaining licensing forms, training videos and other provider resources can be obtained at www.ccld.ca.gov

· Licensees may register to receive child care updates: www.myccl.ca.gov

The immunization records will be sent to our department within 30 days.

There are no deficiencies cited during this inspection.

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

LIC809 (FAS) - (06/04)

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