013421192-1-10-2020-52-CC-EWOS-BKPRZP-20200110122817

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421192
Report Date: 01/10/2020
Date Signed: 01/10/2020 12:28:22 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:	TUCK, NELVA		FACILITY NUMBER:	013421192
ADMINISTRATOR:	TUCK, NELVA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 825-9925
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94542
CAPACITY:	14	CENSUS: 9	DATE:	01/10/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:07 AM
MET WITH:	Nelva Tuck		TIME COMPLETED:	12:47 PM

NARRATIVE

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On 01/10/2020 at approximately 11:07 AM, Licensing Program Analyst (LPA) Elimika Woods met with licensee Nelva Tuck for an Unannounced Random Inspection. Present for this visit was two infants, seven preschool aged children and the licensee’s fingerprint clear associate, Dorotea Soto . There was no one else present during the inspection. The home was toured to conduct a Health and Safety Inspection. The facility currently plans to operate 7:30 AM until 5:00 PM., Monday through Friday

On-limit-areas include: The entire home is used for childcare including the backyard

Off-limit-areas include: Will be inaccessible by child safety gates, closed and/or locked doors and visual
supervision.

The home is a single story, which is neat and clean with heating and ventilation for safety and comfort. The licensee’s son lives in a separate unit directly behind the main house in the back, which is off limits and inaccessible by closed and/ or locked doors and visual supervision. The ISOLATION AREA will be the living room away from children in care. The outdoor play area is fenced and is free from defects and dangerous conditions. The rear of the yard has a play structure on the left side, which is anchored to the ground and has rubber playground mulch for safety. The right side of yard has a large trampoline surrounded by netting.
LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during today inspection. There are ample age appropriate toys, learning materials, and equipment that appear to be safe and in good condition. The home has a fully charge 3A40BC fire extinguisher, dual working smoke detector/carbon monoxide detector, working telephone and First Aid Kit. The licensee’s Health and Safety training is completed, and CPR and First Aid certificate is current and expires 05/05/2020.
The licensee conducts and documents fire and disaster drills at least twice a year, and the log indicates a drill was conducted 10/07/2019. There are no fireplaces or wall heaters. Per licensee, there are no firearms in the home. All required forms are posted and visible for public review. The licensee is in compliance with the immunization laws which pertains to all day-care providers.

See 809-C for continuance

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020

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: TUCK, NELVA	FACILITY NUMBER: 013421192
	VISIT DATE: 01/10/2020

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At 11:45 PM, LPA Woods requested to review three (3) children’s facility files. Each file contained completed Identification & Emergency forms, Medical Consent, and Immunization.

Incidental Medical Services (IMS) -Per the licensee, there are no children on any form of medication. The licensee is not providing IMS currently.

LPA reminded the licensee of the following; Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. LPA discussed Unusual Incidents Reports.

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

The licensee was 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. The licensee was reminded of the responsibility as a mandated reporter.

The 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. The licensee was given a copy of A Child Care Provider's Guide to Safe Sleep pamphlet.

This report shall remain on file for 3 years. A Notice of Site visit was given to licensee, and licensee was reminded that it is required to be posted for 30 days. Exit interview conducted.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020

LIC809 (FAS) - (06/04)

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