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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422117
Report Date: 06/10/2019
Date Signed: 06/10/2019 02:01:05 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:REED, ALICIAFACILITY NUMBER:
013422117
ADMINISTRATOR:REED, ALICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 359-2460
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY:14CENSUS: 13DATE:
06/10/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Alicia ReedTIME COMPLETED:
02:15 PM
NARRATIVE
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On 06/10/19, Licensing Program Analyst Briana Plumboy and Diana Campos met with licensee Alicia Reed for an UNANNOUNCED POC INSPECTION. Present for this visit was 2 infants, 11 preschool age children, and assistant Sandleen Belgaumi. The home was toured, record reviews were conducted, and a physical census was taken.

A POC inspection was conducted today to correct the ratio violation on 06/04/19. On 06/04/19, licensee was cited for RATIO because there were 4 infants and 9 preschool age children present at the facility. Today the licensee and her assistant S.Belgaumi are present with 2 infants and 11 preschool age children. The licensee is OUT OF RATIO during today's inspection. 13 children's files were reviewed. Licensee is being assesed $250 for the repeat ratio citation on 06/04/19, and assessed $100 per day until the citation is resolved. 13 childrens files were reviewed today and 4 out of the 13 files contained the Lic. 9224 form from 06/04/19.

The attached Type A deficiency is cited today for Ratio. Licensee shall obtain Lic. 9224's for each child in care for 06/04/19 and 06/10/19. Upon receipt, licensee shall post for 30 days and provide copies of this licensing report to parent/guardians of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 Acknowledgement of Receipt of Licensing Reports should be signed by guardians and placed in each child’s file. LPA Plumboy provided licensee with copies of Lic. 9224 for both current children in care and newly enrolled children in care.

A non compliance conference will be held in the Oakland South Regional Office which is located at 1515 Clay St. suite 1102 Oakland, CA 94612 on JUNE 17, 2019 at 11:00am.


See 809-D for deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and appeal rights provided.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2019
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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: REED, ALICIA
FACILITY NUMBER: 013422117
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/11/2019
Section Cited
CCR
102416.5(a)
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102416.5(a) Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided.
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Licensee is to immediately reduce numbers to within capacity specified on license and watch the ratio/capacity video on the ccld.ca.gov website. Licensee must send LPA Plumboy an email as soon as her facility is in compliance to stop civil penalty.
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This requirement is not met as evidenced by:
Based on observation, a physical census, and interview, facility is out of ratio today with 2 infants and11 preschool age children in care which poses an immediate health and safety risk to children in care.
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LPA to revisit to ensure Licensee is remaining within RATIO. Licensee was assessed $250 CIVIL PENALTY on 6/4/19 for a repeat violation from 08/01/18, and $100 per day until POC is recieved.
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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: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2019
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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: REED, ALICIA
FACILITY NUMBER: 013422117
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/17/2019
Section Cited
HSC
1596.8595(c)
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Health and Safety Code Section 1596.8595 (c) A licensed child care home shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as specified in paragraph (1) of subdivision (a) of Section 1596.893b.
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On 06/17/19, licensee will bring the Lic.9224 for the inspections on 06/04/19 and 06/10/19 to the conference for all enrolled children in care.
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This requirement was not met as evidenced by:
Based on observation:LICENSEE FAILED TO NOTIFY PARENTS OF TYPE A DIFICENCIES AS WELL AS DID NOT RECEIVE SIGNED LIC.9224 FORMS, which poses a potential health and safety risk to children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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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: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2019
LIC809 (FAS) - (06/04)
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