013421446-6-8-2021-02-CC-ASIH-C3SR43-20210608124052

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421446
Report Date: 06/08/2021
Date Signed: 06/08/2021 12:41:04 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, ELIZABETH		FACILITY NUMBER:	013421446
ADMINISTRATOR:	ROLLINS-RUCKER, ELIZABETH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 604-6262
CITY:	ALAMEDA	STATE: CA	ZIP CODE:	94501
CAPACITY:	14	CENSUS: 5	DATE:	06/08/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Elizabeth Rollins-Rucker		TIME COMPLETED:	01:00 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 06/08/2021 Licensing Program Analyst (LPA) Arminder Singh met with Licensee, Elizabeth Rollins-Rucker and her daughter who is her assistant for an unannounced random annual inspection at 11:15AM. LPA arrived when children were napping and soon after woke up for lunch time. There are 5 children present (two infants and two preschoolers, and one school aged grandosn. Licensee is in ratio for today's inspection. Records of four children (C1-C4) 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. The Licensee's hour of operation are 7am - 6pm, Monday-Friday. 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, working carbon monoxide detector, and fully stocked first aid kit. 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 (last conducted on 04/15/2021). Her Pediatric CPR and First Aid certificates are current and expire on 10/2022. 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: 06/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

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: ROLLINS-RUCKER, ELIZABETH	FACILITY NUMBER: 013421446
	VISIT DATE: 06/08/2021

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

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

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

LIC809 (FAS) - (06/04)

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