013422081-7-23-2021-02-CC-PDYR-C57SFA-20210723135002

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422081
Report Date: 07/23/2021
Date Signed: 07/23/2021 01:50:12 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:	KISLING, CYNTHIA		FACILITY NUMBER:	013422081
ADMINISTRATOR:	KISLING, CYNTHIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 927-0568
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94603
CAPACITY:	14	CENSUS: 10	DATE:	07/23/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Cynthia Kisling		TIME COMPLETED:	02:00 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	An unannounced Required - 1 Year inspection was conducted by Licensing Program Analyst L. Dyer. LPA arrived at the facility at 9:50 a.m. The licensee was present with 10 day care children (1 infant, 6 preschool-age and 3 school-age), and her fingerprint cleared mother and daughter. All staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Phone number and e-mail address are current. Hours: 7:00 a.m. - 5:30 p.m. Day care area of the home was inspected. Areas licensed for child care: living room, dining room and the bathroom. Off-limit areas will be made inaccessible to children by closed and/or locked doors; and visual supervision. The home was clean and orderly, with adequate ventilation. Windows were open. There were safe, healthful and comfortable accommodations, furnishings and equipment available to children at the time of this inspection. There were a variety of books and toys for children's use. There was a working smoke detector (tested); a fully charged 3-A:40-B:C fire extinguisher; a first aid kit, and a carbon monoxide detector. Fireplace was blocked by play equipment. There are no hazardous materials, medicines, or cleaning solutions accessible to children during this inspection. Hazardous items are kept locked in a low cabinet, or high out of children's reach. Licensee stated there were no firearms or bodies of water on the premises. Front yard area is securely fenced. Licensee has a water table, teeter totter, chalk, riding toys, a child size house and other outdoor toys for child play. All required forms are posted and visible for public review. Last disaster drill date logged: 5/19/21. There is an Individual Sleeping Plan for each infant up to 12 months of age, which is in the child's file. Signatures were reviewed. Documentation has been maintained for each 15 minute nap check. Licensee states infants have been supervised while sleeping, and is aware of the signs to be aware of: labored breathing, skin color, increase in body temperature and restlessness. Licensee states that infants sleep on their backs. There is no children with a Sleeping Plan with Section C in place. Infants sleep in the living room, and the licensee can visually observe when a child awakens from a nap. (continued)

SUPERVISOR'S NAME: Phyllis Dyer	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KISLING, CYNTHIA	FACILITY NUMBER: 013422081
	VISIT DATE: 07/23/2021

NARRATIVE

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Play yards were reviewed for each infant up to 12 months of age. Placement did not hinder the entrance or exit to and from the sleeping space. Mattresses were firm, sized appropriately, and were covered with a tightly fitted sheet. There are no objects hanging above or attached to the play yard, and no bumper pads. No pacifiers were seen. Older children sleep on cots. Licensee states sheets are replaced when soiled or wet, and individual bedding is only used by one child only. Soiled bedding is placed in a closed bag and is inaccessible until washed. Bedding is sent home to be washed weekly.

At 12:05 p.m., a sample of children's files were reviewed. Facility roster will be e-mailed. Immunizations were previously reviewed. Mandated Reporter Training certificate (Child Care Module) expires 5/19/2023; and Pediatric First Aid/CPR training expires 8/2022.

Individual 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.

Guidance for Child Care Providers and Programs (version June 29, 2021), New Safe Sleep Regulations, and Individual Sleeping Plans for Infants were provided and discussed with the licensee. Licensee was reminded of the Department's Inspection authority, and the need to comply when notified that termination of an employee is necessary. Also discussed with the licensee: supervision of children at all times; swaddling; children are not to be left in parked vehicles; carseats are not to be used for sleeping; substitutes available; advertisements; changes in on-limit areas; construction work at facility; paying fees on-line; smoking; fingerprinting; ill children, and the new Guardian background check process. A qualified assistant must be physically present whenever 9 or more children are in care. When an assistant is not present, the home reverts back to small family child care ratios.

Licensee was encouraged to frequently visit the licensing website at www.ccld.ca.govfor licensing regulations, forms and updates. (continued)

SUPERVISOR'S NAME: Phyllis Dyer	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KISLING, CYNTHIA	FACILITY NUMBER: 013422081
	VISIT DATE: 07/23/2021

NARRATIVE

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Important E-mail Addresses:
Community Care Licensing General Information: www.ccld.ca.gov.
Mandated Reporter Training: www.mandatedreporterca.com
Alameda County Public Health Department Website: www.acphd.org
Guardian: background check process with self-service options: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

NO DEFICIENCIES CITED TODAY.

Exit interview conducted. Appeal rights were discussed and given. Notice of site visit must be posted for 30 days. This report must be available for public review for 3 years.

SUPERVISOR'S NAME: Phyllis Dyer	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

LIC809 (FAS) - (06/04)

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