<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421952
Report Date: 02/06/2020
Date Signed: 02/06/2020 03:06:22 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:TOURE, MARIEMOUFACILITY NUMBER:
013421952
ADMINISTRATOR:TOURE, MARIEMOUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 809-6097
CITY:BERKELEYSTATE: CAZIP CODE:
94703
CAPACITY:14CENSUS: 5DATE:
02/06/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Licensee Mariemou ToureTIME COMPLETED:
04:00 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 02/06/2020, Licensing Program Analyst (LPA) Brittany Newton made an unannounced visit for the purpose of conducting a required annual inspection. LPA was met by licensee Mariemou Toure. Present for the visit was two infants and two preschool aged children. Later, the licensee’s spouse and daughter joined the visit. The home was toured to conduct a health and safety inspection.

The home is a single story home, which is neat and clean with heating and ventilation for safety and comfort. The home consists of the living room, family/play room, eat-in kitchen, bathroom, two bedrooms, and laundry room. All areas of the home are on limits. The isolation area for sick children is the area next to the play room. The licensee states that they take children to the local park for outdoor play, but will occasionally use the backyard for play. The backyard is shared with other units, so the licensee is reminded to have 100% visual supervision when children are in the yard and when they are away from the home with children. There are an ample supply of age appropriate toys and activities that are in good condition. LPA did not observe any bodies of water or hazardous or toxic items accessible to children today. Per licensee, there are no firearms in the home. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, carbon monoxide detector, telephone, and fully stocked first aid supplies. Fire and Disaster Drills have been being conducted with the last one being 12/10/2019. CPR and First Aid is current and expiring 02/2022. LPA reviewed children files. Required forms were not posted. LPA consulted with licensee about the posting requirements and provided the licensee with the following forms: A new license, a Emergency Disaster Plan, Personal Rights of children, and Notification of Parent Rights. LPA is reminding licensee to ensure these forms are posted during operating hours. LPA used the assistance of Language Services to interpret some of the needed requirements that needed to be discussed.


Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. Currently, the licensee has no kids in care requiring medicine. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Brittany NewtonTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020
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: TOURE, MARIEMOU
FACILITY NUMBER: 013421952
VISIT DATE: 02/06/2020
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
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 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 .



A child care roster will be submitted to LPA Newton at a later date. The Licensee was given a copy of A Child Care Provider's Guide to Safe Sleep pamphlet and LPA discussed safe sleep practices, policy, and consulted with Licensee to answer questions. Licensee is reminded to ensure that when infants are sleeping, the door is not closed and to ensure that she is checking on them every 5 to 10 minutes to ensure the health and safety.

A deficiency was cited at this visit and must be corrected by the due date. A Notice of Site visit was given and facility was reminded that it is required to be posted for 30 days. Exit interview conducted, appeal rights provided, and a copy of this report was left with Licensee Mariemou Toure.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Brittany NewtonTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020
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: TOURE, MARIEMOU
FACILITY NUMBER: 013421952
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/20/2020
Section Cited

1
2
3
4
5
6
7
Child's Records. The licensee shall maintain, in each child's record, a copy of the emergency information card required in Section 102417(g)(7). This requirement was not met as evidenced by:
8
9
10
11
12
13
14
Based on record review, the licensee does not have the LIC 700 for any of the children enrolled which poses a potential Health, Safety, or Personal Rights risk to children in care.
8
9
10
11
12
13
14
Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat
Violations are $250.00 per violation and $100.00 per day until corrected.

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Sherelle JohnsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Brittany NewtonTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3