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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421192
Report Date: 11/07/2022
Date Signed: 11/07/2022 12:24:39 PM


Document Has Been Signed on 11/07/2022 12:24 PM - It Cannot Be Edited

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, NELVAFACILITY NUMBER:
013421192
ADMINISTRATOR:TUCK, NELVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 825-9925
CITY:HAYWARDSTATE: CAZIP CODE:
94542
CAPACITY:14CENSUS: 9DATE:
11/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:46 AM
MET WITH:Nelva TuckTIME COMPLETED:
12:23 PM
NARRATIVE
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On 11/07/2022 at 9:46am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Nelva Tuck for an Unannounced Annual Inspection. Present during the inspection was the Licensee, her helper, Dorotea Soto, two (2) infants and seven (7) preschool age children. The facility operates in the main house which is in the front of the property closest to the main street. There is a separate home behind the main home on the property that the Licensee lives in. Children do not have access to the second home, and it remains locked during business hours. The facility currently operates 7:30am – 5:30pm, Monday – Friday.

ON LIMITS AREA: Entire main home (Living Room, Dining Area, Kitchen, One (1) Bedroom, One (1) full Bathroom, used for adults, One half bathroom, used for children, backyard, and side yard on the left side of the home)
OFF LIMITS AREA: Basement and Home behind the main home (consists of two (2) bedrooms, one (1) bathroom, Living Room and Kitchen)
ISOLATION AREA: Living Room

The facility is a single-story home. The home is owned by Licensee’s oldest son. The inside and outside of the home were observed to be neat, clean with ample age appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. Licensee provides all food for the children in care. Any food brought from the children’s home will be properly stored and labeled. Licensee stated there are no firearms and there is one (1) rabbit in the backyard.

Continued on LIC809-C

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2022
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 6


Document Has Been Signed on 11/07/2022 12:24 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/14/2022
Plan of Correction
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Licensee and her helper will complete the Mandated Reporter training. Licensee will send LPA Pringle a copy of the certification of completeion by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2022
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: 11/07/2022
NARRATIVE
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The home has one (1) fully charged 3A40BC fire extinguisher in the nook area by the kitchen. There is one (1) working smoke/carbon monoxide detector in dining room. The home is equipped with central heat and air for proper ventilation. The backyard of the home is fully fenced, clean and properly maintained. The play structure is anchored into the ground and well maintained. There is a large trampoline in the backyard that is not in use and one small trampoline that is used by the children. The trampoline is low to the ground and has a protective mesh netting around it for safety. LPA did not observe any harmful bodies of water in or around the home.

Licensee is operating within their licensed capacity and is in ratio. Licensee’s Health and Safety training has been completed. Licensee’s Pediatric CPR and First Aid training is complete and expires 7/18/2023. Licensee and helpers Mandated Reporter training has expired as of 1/2022 (See LIC809D). Fire/disaster drill log is complete with last drill logged 6/17/2022. All required postings are made visible in the living room. LPA obtained the facility files, helpers file, and children’s files. During LPA’s record review it was found that Licensee’s helper was missing a record for the MMr immunization (See LIC9102TV). Licensee’s was also missing a record of the Infants sleep (See LIC9102TV). All other files were complete.

Deficiencies Cited During Inspection
· Licensee and Helper have expired Mandated Reporter Training certificates

Licensee was reminded that California Law requires Licensee to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com.

Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. The Licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.
Continued on LIC809-C
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: 11/07/2022
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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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days.


Exit interview conducted and report was reviewed with Licensee Nelva Tuck.

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6