013421935-5-20-2022-52-CC-RHAR-CELVHB-20220520162651

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421935
Report Date: 05/20/2022
Date Signed: 05/20/2022 04:26:59 PM

Document Has Been Signed on 05/20/2022 04:26 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	WILSON, DANA		FACILITY NUMBER:	013421935
ADMINISTRATOR:	WILSON, DANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 321-1232
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY:	14	CENSUS: 3	DATE:	05/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Dana Wilson		TIME COMPLETED:	04:31 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 May 20, 2022 at approximately 1:55pm Licensing Program Analyst (LPA) Haderer arrived and met with the licensee Dana Wilson for the purpose of conducting an unannounced 1-year annual inspection for Health and Safety compliance. Present in the home today was the licensee, her fingerprint and TB tested assistant and 3 children in care (2 infants; 1 two-years old). The facility is in ratio today. Hours of operation are Monday-Friday 8:00 to 6:00pm. The facility is a single-story home with 3 bedrooms; 2 bathrooms; living room; family room (day care are); dining room; kitchen; attached 2-car garage; front, back and side yards. The home has heating and ventilation for safety and comfort. Per the licensee, the ISOLATION AREA will be in the outside or inside area away from the other children in care. All required postings are present. ON LIMIT AREAS: Family room (day care area), house bathroom, patio area of the backyard, and side yard to enter from the street. Licensee was reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) such as cleaning products. OFF LIMIT AREAS: Living room, kitchen, all three bedrooms, and master bathroom, attached 2-car garage; north side of the back yard and side yard to the north and front yard. The off-limit areas will be inaccessible by child gates, closed and/or locked doors and/or adult supervision. The home has a fully charged 2A10BC fire extinguisher mounted on the wall next to the entrance to the kitchen, combined smoke and carbon monoxide detector (tested and working) and a working telephone. Fire drills are conducted at least once every 6 months, the last drill was completed May 1, 2022.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022

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
	VISIT DATE: 05/20/2022

NARRATIVE

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Licensee has ample age-appropriate toys and learning materials inside and outside the home. The outdoor play area is free from defects and dangerous conditions. There is a locked shed inaccessible to children by the locked handle. Per licensee, there are no firearms in the home. Drop-down cribs are not allowed at the day-care facility. Toxins, medicines, and hazardous items were inaccessible during today's inspection.

At 3:05pm, LPA reviewed Children’s files. The facility roster was reviewed, and a copy obtained. All files were organized and complete. The licensee rents the property and does not carry liability insurance. All children’s files contained the LIC282 Notice of no insurance and all were signed and dated. Facility files were also checked and in good order.

Licensee and helper have all required immunizations. CPR/1^st Aid was available for licensee and assistant, both expire on 11/3/2022. Mandated Reporter was completed on 11/2/2020. Licensee was reminded that CPR/1st Aide and Mandated Reporter is to be renewed every two years.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022

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
	VISIT DATE: 05/20/2022

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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

There were no deficiencies issued today. The report will remain on file for three years.

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

Exit interview conducted and report was reviewed with the licensee Dana Wilson.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022

LIC809 (FAS) - (06/04)

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