013421865-3-22-2023-52-CC-SCOZ-CQ6PAU-20230322110919

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421865
Report Date: 03/22/2023
Date Signed: 03/22/2023 11:10:28 AM

Document Has Been Signed on 03/22/2023 11:10 AM - 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	AYCHILUHIM, TEGEST		FACILITY NUMBER:	013421865
ADMINISTRATOR:	AYCHILUHIM, TEGEST		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 200-1956
CITY:	SAN LEANDRO	STATE: CA	ZIP CODE:	94577
CAPACITY:	14	CENSUS: 10	DATE:	03/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Tegest Aychluhim		TIME COMPLETED:	01:00 PM

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Licensing Program Analyst Sidney Cortez,and Andrew Elliott met with licensee for Tegest Aychiluhim, for an UNANNOUNCED ANNUAL RANDOM INSPECTION. Present for this visit was the licensee Tegest Aychiluhim, her fingerprint husband Mekaunit M, and her staff Marta U. and Carmen Orth and 1 infant and 10 pre-school age child. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 7:00AM until 5:30 PM, MONDAY-FRIDAY.

The home is a two-story house consisting of 5 bedrooms, two and half bathrooms, living room, dining room, office room, kitchen, and backyard. - Day care area: The main daycare area which consists of the main daycare room, daycare napping room, two bathrooms, kitchen, dining area, front enclosed outside area, and backyard. Off limit areas: The main living quarters of the home separate from the main daycare rooms and the garage. The isolation area will be the right side of the house (2nd room).

There is a fully fenced outdoor yard and play area. There are ample age appropriate toys and furnishings that are safe and in good repair. There are no pools, hot tubs or any other accessible bodies of water. All hazardous materials and toxins are kept out of the reach of children. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone. The licensee’s Health and Safety training is completed and CPR and First Aid certificates are current and expire JAN 2024. The licensee is in compliance with new immunization laws which pertain to day care providers. Per licensee, there are no firearms in the home.

The licensee's mandated reporter training is current and expires (March, 2025). The licensee conducts and documents fire and disaster drills twice a year with the last one conducted in March, 2023. 5 Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Sidney Cortez	TELEPHONE: (510) 295-5031
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: AYCHILUHIM, TEGEST	FACILITY NUMBER: 013421865
	VISIT DATE: 03/22/2023

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Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov.

LPA Cortez provided a copy of Safe Sleep-in child care brochure, a handout "What Does A Safe Sleep Environment Look Like," and a copy of the new California Car Seat Law Changes. The licensee was provided information regarding effects of Lead Exposure and testing requirements (Assembly Bill 2370).

This home is recommended for licensing. This report shall remain on file for 3 years. Exit interview conducted with licensee.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Sidney Cortez	TELEPHONE: (510) 295-5031
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC809 (FAS) - (06/04)

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