013421446-8-12-2024-02-CC-CFES-D83V64-20240812160854

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421446
Report Date: 08/12/2024
Date Signed: 08/12/2024 04:09:01 PM

Document Has Been Signed on 08/12/2024 04:09 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:	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: 8	DATE:	08/12/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Elizabeth Rollins-Rucker		TIME COMPLETED:	04:15 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 8/12/2024 at 1:00pm, Licensing Program Analysts (LPAs) Catherine Fernandes and Mario Caro met with Licensee Elizabeth Rollins-Rucker for an Unannounced Random Inspection. Present during the inspection were three infants, five preschoolers and one school age child in care and two fingerprint cleared staff members. Residing in the home is Licensee, her finger print cleared adult daughter and son in-law, and underage child. Licensee’s home was toured for a health and safety inspection. The facility operates 7:00am – 6:00pm, Monday - Friday. The home is a part of the Summer House Apartments on the first floor that consists of three bedrooms and two bathrooms. The inside and outside of the home were observed to be neat, clean with age-appropriate materials and toys for the children. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. Heaters vents are located on the ceilings and the inaccessible rooms were locked during todays inspection. Licensee stated there are no firearms and no pets in the home. LPAs did not observe a body of water in or around home. ON LIMITS AREA: The living room which is the main are of the day care, the second bedroom on the right side of the hallway that is used during nap time for the infants, the bathroom on the left side of the hallway, and the fenced in patio area. OFF LIMITS AREA: The kitchen, the bathroom at the end of the hallway, the first bedroom on the right side and the last bedroom on the right side which will be inaccessible by closed and/or locked doors or visual supervision. ISOLATION AREA: on the couch in the living room REPORT CONTINUES ON 809C

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2024

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: 08/12/2024

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
26
27
28
29
30
31
32

The home has a fully charged 2A10BC fire extinguisher in the closet next to the front door, a working smoke detector/carbon monoxide detector, and a push button alarm located in the hallway. Licensee has a working telephone, and all required forms are posted and visible for public view in the entrance of the childcare room. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 7/15/24 The Licensee's CPR and First Aid certificate is current and expires on 7/20/24. The Licensee was reminded of the responsibility as a mandated reporter and has provided proof of the required training for all people caring for children which was conducted on 10/27/23. LPA reviewed children’s files and all staff files and obtained a current facility roster.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
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-andresources/safe-sleep as an additional resource. LPA also informed licensee 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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 the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

REPORT CONTINUES ON 809C.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2024

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
	VISIT DATE: 08/12/2024

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
26
27
28
29
30
31
32

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

No deficiencies were observed during today's inspection.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Licensee
Appeal rights, report and Notice of site visit provided.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2024

LIC809 (FAS) - (06/04)

Page: 3 of 3