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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421446
Report Date: 01/14/2020
Date Signed: 01/14/2020 03:10:25 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:ROLLINS-RUCKER, ELIZABETHFACILITY NUMBER:
013421446
ADMINISTRATOR:ROLLINS-RUCKER, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 604-6262
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY:14CENSUS: 5DATE:
01/14/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Elizabeth Rollins-RuckerTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analysts Arminder Singh and Monica Mathur met with Licensee, Elizabeth Rollins-Rucker for an unannounced random annual inspection at 01:15PM. There are 5 children present (four infants and one preschooler. Licensee is out of ratio in today's inspection since licensee is caring for children all by herself today.Licensee's assistant who is also her daughter, was away from the facility during inspection. Regulation requires licensee shall comply with capacity requirements for a Small Family Child Care Home if no assistant provider is present. Records of all five children were reviewed and are complete. The home was toured to conduct a health and safety inspection.

The home is a one story home which is located in the Summer House Apartments Complex. Access is thru the Poggi St gate which is open from 7am - 6pm, seven days a week. The home consists of a living/dining room, kitchen, 3 bedrooms, 2 bathrooms, and a balcony. The ON LIMIT AREAS are the living/dining room, kitchen, bathroom 1 located across from the bedroom #3 which is also on limits, and the balcony. The remainder of home is OFF LIMITS which will be inaccessible by closed 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. All hazardous materials and toxins are kept out of reach of children.

The home has a fully charged 2A10BC fire extinguisher, working smoke detector, and carbon monoxide detector. There is centralized heating that is working and in good repair. Licensee states there are no firearms in the home. The bedroom #2 is the isolation room. She conducts fire/disaster drills every six months. Her Pediatric CPR and First Aid certificates are current and expire on 09/2020. She has a first aid kit.

Please see LIC 809 C for additional information
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020
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 3
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: ROLLINS-RUCKER, ELIZABETH
FACILITY NUMBER: 013421446
VISIT DATE: 01/14/2020
NARRATIVE
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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.

· 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

Due to the issuance of a Type A citation, a copy of this report must be posted and given to each existing parent by the end of day or next day child is in care. Report also has to be provided to parents of children enrolled over the next 12 months. In addition, a copy of LIC9224 Acknowledgement of Receipt of Licensing Report must be signed and kept in each child's file.


A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted.
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: ROLLINS-RUCKER, ELIZABETH
FACILITY NUMBER: 013421446
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/14/2020
Section Cited

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102416.5 Staffing Ratio and Capacity.(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home[...] This requirement is not met as evidenced by:
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Per LPA's observation Licensee was alone with 4 infants and 1 preschooler. Her assistant was away from home during inspection. When no assistant is present, Licensee is required to follow capacity requirements of a Small Family Home. This poses an immediate risk to the health and safety of children.
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Due to the issuance of a Type A citation, a copy of this report must be posted and given to each existing parent by the end of day or net day child is in care. Report also has to be provided to parents of children enrolled over the next 12 months. In addition, a copy of LIC9224 Acknowledgement of Receipt of Licensing Report must be signed and kept in each child's file.

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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: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3