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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421935
Report Date: 10/23/2020
Date Signed: 10/23/2020 02:39:36 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:WILSON, DANAFACILITY NUMBER:
013421935
ADMINISTRATOR:WILSON, DANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 321-1232
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:14CENSUS: 6DATE:
10/23/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Dana WilsonTIME COMPLETED:
03:02 PM
NARRATIVE
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On October 23, 2020 at approximately 9:38am Licensing Program Analyst (LPA) Russ Haderer and Licensing Program Manager (LPM) Chandra Charles met with Licensee Dana Wilson to investigate a complaint regarding her Physical Plant. Present during the inspection was the finger print cleared Assistant Lilia Valientedefranco, (4) day-care children and License's own two children ages 4, 7 (2 children) & 8 (2 children) and 9 years old.

LPA and LPM toured the areas accessible to the day-care children, for a Health & Safety inspection. LPA requested and obtain a copy of the currently children facility roster. LPM Charles, reviewed children and employee facility files.

During the course of the complaint investigation and tour the following deficiencies were observed:

- There was 3 inches of standing water located in an accessible circular metal raised garden bed without a cover or locked lid.
- Facility Roster was out of date
- Licensee and Employee CPR/1st Aide certifications were out of date
- Licensee and employee Manadated Reporter certifications were out of date
- Fire extinguisher needs to be recharged
- Carbon Monoxide detector was non-functioning
- Smoke Detector was not working properly, constantly ringing when battery was in place


SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2020
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: WILSON, DANA
FACILITY NUMBER: 013421935
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/23/2020
Section Cited

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102417 (5) Operation of a Family Child Care Home - All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools,hot tubs, spas, fish ponds and similar bodies of water through a pl cover or by surrounding the pool with a
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 fence. (LPM) Chandra Charles, observed a large round metal flower bed container used as a makeshift pool, which had approximately 3 inches of free standing water inside the container. There was no cover over the top to prevent access by children.
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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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2020
LIC809 (FAS) - (06/04)
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