013421185-8-12-2019-02-CC-SNEN-BEYVNL-20190812163519

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421185
Report Date: 08/12/2019
Date Signed: 08/12/2019 04:35:26 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:	FIALKOWSKI, MARIA & STEVEN		FACILITY NUMBER:	013421185
ADMINISTRATOR:	FIALKOWSKI, MARIA & STEVEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 778-0865
CITY:	ALBANY	STATE: CA	ZIP CODE:	94706
CAPACITY:	14	CENSUS: 3	DATE:	08/12/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Maria Fialkowski		TIME COMPLETED:	05:00 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	An unannounced Annual/Random site inspection visit was conducted by LPA Susan Neeson. Met with Maria Fialkowski. Visit began at 2:10 PM. She resides here with her husband. Her mother is her main helper when needed. All three adults have current CPR and First Aid certification. There are 2 infants and one preschool child present, All adults are fingerprint clear and associated with the facility. The home has two floors and a basement. Day care is done in living/dining area, kitchen and family room. One bedroom on the first floor is used for napping. The children use the 3/4 bathroom adjacent to the family room if they are old enough. The bath off the main floor bedroom is off-limits. The upstairs loft area is off-limits as is the basement/garage/music room. The bathroom contains no hazards. None of the children currently in care use the bathroom. The kitchen was inspected and contains no hazards. Knives and cleaning products are locked up. The back yard is also be off-limits and outdoor play, weather permitting, will be done at a nearby park. Electrical outlets are covered. Cleaning products, medicines and other dangerous items are out of children's reach. There is no body of water. The fire extinguisher is mounted on the wall in the kitchen. The smoke detector works. There is a carbon monoxide detector. Fire or earthquake drills are documented. Children's records are maintained. There are adequate toys and equipment for the children in care. Maria Fialkowski states that there are no guns or firearms in the home. 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. All forms can be downloaded at www.ccld.ca.gov and for day care updates visit www.myccl.gov.

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan Neeson	TELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: FIALKOWSKI, MARIA & STEVEN	FACILITY NUMBER: 013421185
	VISIT DATE: 08/12/2019

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

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

The following documents were issued: Licensee Rights, Safe Sleep concepts for infants, Safe and Healthy Diapering, California Child Passenger safety law, fire and earthquake drill form, blue card, AB 1207 provider training, Department Quarterly Updates Winter 2019 and Spring 2019 and flu prevention tips.

No deficiencies are observed. An exit interview was given.

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan Neeson	TELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2