013421274-8-10-2021-02-CC-ASIH-C5RRYK-20210810132627

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421274
Report Date: 08/10/2021
Date Signed: 08/10/2021 01:27:10 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:	CALLIRGOS, MANUELA		FACILITY NUMBER:	013421274
ADMINISTRATOR:	CALLIRGOS, MANUELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 508-2462
CITY:	ALAMEDA	STATE: CA	ZIP CODE:	94501
CAPACITY:	14	CENSUS: 3	DATE:	08/10/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Manuela Callirgos		TIME COMPLETED:	02:00 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	On 08/10/2021 at 01:00 PM Licensing Program Analyst (LPA) Arminder Singh met with Licensee Manuela Callirgos and Daughter, Joycie Shinzato for an unannounced random annual inspection. There are 3 children present today. During inspection there was the Licensee and Daughter present. Days and hours of operation are Mon - Friday, 8 AM to 5:00 PM. The home is a one story home with an attached garage. The home consists of a kitchen, living room, dining room, family room, four bedrooms, two bathrooms, and a backyard. The ON LIMIT AREAS are the the family room, front bedroom, hallway, bathroom #1, and backyard. The OFF LIMITS area is garage, bedroom #2, bedroom #3, bedroom#4,bathroom#2, and kitchen. Off limit areas will be inaccessible by closed, gated and or/locked doors and visual supervision. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs, or any other bodies of water. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, and carbon monoxide detector. The home does have a fireplace that is not being used and is made inaccessible with a barricade. Licensee states there are no firearms in the home. Licensee does not have any pets. Fire/disaster drills are conducted every six months and are logged. Last drill was conducted on 07/07/2021. The living room is the isolation room. Licensee does have a fully stocked first aid kit. At 1:30PM two (2) children's records were reviewed by the LPA and files are complete. Licensee and Daughter both have current Pediatric CPR and First Aid certificates and expire on 04/2022. LPA has obtained a copy of the current children's roster. Please see LIC 809 C for additional information

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2021

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: 08/10/2021

NARRATIVE

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Outdoor Yard: The outdoor play area is free from defects or dangerous conditions and is fully fenced. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies or hazardous materials and toxins are kept out of the reach of children. The outdoor play area is fully fenced and has padded surface. Licensee understand that 100% supervision is required at all times.

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.

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.

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.

Beginning January 1, 2019 AB 2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families.
"Mandated Reporter" training for CA Child Care Providers that all staff are required to complete as of January 1, 2018. [Starting May 2019, both General Training followed by Child Care Providers Training is required to be taken]. The website for the online training is: http://www.mandatedreporterca.com/training/childcare.htm.

CONTINUED ON NEXT PAGE

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2021

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: 08/10/2021

NARRATIVE

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· 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

Website for provider resources:
http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

childcareadvocatesprogram@dss.ca.gov

In the areas that were evaluated, no regulatory violations were observed.

At 01:30 PM Exit Interview was conducted, where this report was reviewed and discussed with Licensee and Daughter. Report was signed by the Licensee confirming receipt of documents.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

END OF REPORT

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2021

LIC809 (FAS) - (06/04)

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