013421292-7-29-2022-02-CC-CCON-CGSV82-20220729161202

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421292
Report Date: 07/29/2022
Date Signed: 07/29/2022 04:12:11 PM

Document Has Been Signed on 07/29/2022 04:12 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	RAYMOND, DOROTHEA		FACILITY NUMBER:	013421292
ADMINISTRATOR:	RAYMOND, DOROTHEA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 938-6666
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94706
CAPACITY:	14	CENSUS: 11	DATE:	07/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:31 PM
MET WITH:	Dorothea Raymond		TIME COMPLETED:	04:26 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 July 29, 2022 at 1:31 PM, Licensing Program Analyst (LPA) Caroline Colson met with Dorothea Raymond, her assistants, Melissa Thowson and Makena Domingo for an unannounced random annual inspection. Hui Tang, Contractor, arrived during the inspection. There are 2 infants and 9 preschool children. The facility's operating hours are Monday - Friday from 8:30 AM to 5:30 PM. LPA toured the facility for a health and safety inspection. Indoor Space: The home is one story home. The home consists of living room, dinning area, kitchen, 2 bathrooms, three bedrooms, fenced back yard, unfenced front yard and a basement. The home has one floor heater and ventilation for safety and comfort. There is an ample amount of toys available. Ms. Raymond states that there are no weapons in the home. All hazardous materials and toxins are stored away from children. The home is equipped with a 3A40BC fire extinguisher, a working combination smoke detector and carbon monoxide detector. All required documents are posted. Pediatric CPR/First Aid certificates are current and expires on September 9, 2023. Mandated Reporter Training certificate is current and expires on June 14, 2023. There are no pets. Outdoor Space: The fenced back yard is the outdoor play space. Children are guided to the back yard by using the internal stairs. The entire area was inspected to ensure the health and safety of the area. There are no pools, hot tubs or any other bodies of water on the premises. Off Limit Areas: The two upstairs bedrooms, one upstairs bathroom, unfenced front yard, and basement are the off limit areas. Please See LIC 809 C for additional information.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022

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: RAYMOND, DOROTHEA	FACILITY NUMBER: 013421292
	VISIT DATE: 07/29/2022

NARRATIVE

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· CCLD Complaint Hotline, 1-844-LET-US-NO (1-844-538-8766) email: LetUsNo@dss.ca.gov

· 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

· Licensees may register to receive child care updates: www.myccl.ca.gov

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 ADA, available at: http://www.ada.gov/childquanda.htm

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.

Licensee will purchase a wood or plastic floor register for the home.

Please See LIC 809 for Additional Information

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: RAYMOND, DOROTHEA	FACILITY NUMBER: 013421292
	VISIT DATE: 07/29/2022

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Family Child Care Homes

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.

Safe Sleep

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee Dorothea Raymond 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.

Notice of Site Visit

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

Exit Interview

Exit interview conducted and report was reviewed with the licensee, Dorothea Raymond.

There were no deficiencies cited during this inspection.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

LIC809 (FAS) - (06/04)

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