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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421274
Report Date: 04/26/2019
Date Signed: 04/29/2019 08:15:02 AM

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:CALLIRGOS, MANUELAFACILITY NUMBER:
013421274
ADMINISTRATOR:CALLIRGOS, MANUELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 508-2462
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY:14CENSUS: 11DATE:
04/26/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:ManuelaTIME COMPLETED:
10:30 AM
NARRATIVE
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I, Licensing Program Analyst, Jason Jang made an annual random inspection to the facility that began at 9:30 am. I met with the Licensee, Manuela who was present with her husband, adult daughter, Joycie, 6 year old granddaughter, three infants, and 7 preschoolers. The Licensee lives at the facility with her husband, Joni Custodio. All of the adults meet the criminal background clearance requirement. The area used for the child care are the family room, front bedroom, hallway, bathroom and back yard. Off limit areas include: Remainder 3 bedrooms, 1 bathroom, kitchen, and garage. The facility had a working smoke detector, carbon monoxide detector and fully recharged size 2A10BC fire extinguisher. All bodies of water such as pools or hot tubs were inaccessible to children. The fire place is blocked off. The home is kept clean and orderly, with heating and ventilation for safety and comfort. A child safety gate was in place at the kitchen. The home has safe toys, play equipment, and materials. The Licensee is present in the home and ensures that children are supervised at all times. Licensee was reminded that children are not to be left alone in vehicles. When temporarily away, the Licensee arranges for a substitute adult to care for the children. The Licensee maintains the capacity on the license. Each child has safe, comfortable, and healthful accommodations, furnishings, and equipment. The Licensee had a current pediatric CPR and first aid certificate. Licensee stated there were no guns or weapons in the home. Licensee has no pets. At 10:00 am, 10 children's file were reviewed and found to be complete with immunization records.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2019
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: CALLIRGOS, MANUELA
FACILITY NUMBER: 013421274
VISIT DATE: 04/26/2019
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Licensee rents the facility. The Licensee is utilizing the child care roster. Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children, or an immediate civil penalty can be assessed. Also discussed: nutrition education; the new appeal process; and documents to be provided to parents/legal guardians. Upon notice of the Department to remove an individual from the home or to exclude an individual from the home, the Licensee immediately removes the individual and prevents them from returning to the home or having contact with children. 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 (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 Please register your email address at childcareadvocatesprogram@dss.ca.gov for all new licensing updates. The Licensee completed the mandated reporter training.

There were no deficiencies cited in today's visit. An exit interview was conducted with the Licensee. Appeal rights were given to the Licensee.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2019
LIC809 (FAS) - (06/04)
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