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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422117
Report Date: 01/12/2023
Date Signed: 01/12/2023 05:48:24 PM


Document Has Been Signed on 01/12/2023 05:48 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
OAKLAND SOUTH EAST, 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: 8DATE:
01/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:ALica ReedTIME COMPLETED:
06:05 PM
NARRATIVE
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On 1/12/2023 at 2:30 pm Licensing Program analyst (LPA) Michael Mathew Conducted an unannounced annual visit LPA met with Licensee Alicia Reed and discussed the purpose of the Visit. Prior to entering the home LPA conducted Covid-19 screening questions. Licensee and LPA toured inside and out of the home. At the time of the visit there were 8 children and 3 adults. There are age-appropriate toys and equipment for children in care.

Licensee uses the living room, playroom, hallway bathroom, and backyard for the day-care. Licensee stated that there are no guns/weapons or ammunition in the home. LPA observed the knifes were in the back of the counter top next to the stove inaccessible to children in care LPA observed chemicals and toxins are kept in in back comer of the kitchen which is inaccessible to children in care. Backyard is fully fenced in and have ample number of toys and equipment for children in care. LPA observed no bodies of water during inspection. LPA observed a 2A10BC fire extinguisher present. Fire alarm and carbon monoxide detector are good and in working condition. Licensees and one assistant do not have a current CPR/first aid certificate. Licensee stated that, licensee had an appointment in December and became ill and reschedule the appointment to February. LPA observed one assistant with a current CPR/first aid valid until 8/20/24. Licensee and one assistant present do have current mandated reporter training valid until 3/15/2024. LPA observed one assistant did not have a current mandated reporter training. Fire drill was conducted on 10/12/22. A sampling of children records was reviewed. LPA observed children's files to be incomplete. LPA observed all children's files missing personal and parent right. LPA observed S1 did not have immunization in S1's folder. S1 has contacted hospital for copy of immunization.

The facility is currently not providing Incidental Medical Services. 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

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: 510-292-8297
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023
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 5


Document Has Been Signed on 01/12/2023 05:48 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: REED, ALICIA
FACILITY NUMBER: 013422117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care. LPA observed that S2 did not have a current mandated reporter training . Licensee was not able to provide a current mandated reporter training to LAP
POC Due Date: 01/26/2023
Plan of Correction
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Licensee agreed to send LPA completed certificate of S2 mandated reporter via email or text by end of day Thursday (1/26/23) Licensee also agreed to send a letter to LPA stating how Licensee will make sure that this won't happen in the future.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care.LPA observed that Licensee was not able to provided a completed CPR/fire aid training for licensee and S2 to LPA during todays inspection
POC Due Date: 01/31/2023
Plan of Correction
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Licensee agreed to send LPA completed certificate of Licensee and S2 CPR/first aid via email or text by end of day Thursday (1/26/23) Licensee also agreed to send a letter to LPA stating how Licensee will make sure that this won't happen in the future.
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) 421-1324
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: 510-292-8297
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5


Document Has Been Signed on 01/12/2023 05:48 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: REED, ALICIA
FACILITY NUMBER: 013422117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care. LPA observed S1 did not have immunization in S1 folder, S1 has contacted hospital for copy of immunization.
POC Due Date: 01/26/2023
Plan of Correction
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Licensee agreed to send copy of S1 immunization to LPA Via email or text by end of day Thursday (1/26/23) Licensee also agreed to send a letter to LPA stating how Licensee will make sure that this won't happen in the future.
Type B
Section Cited
CCR
102419(d)
Admission Procedures and Parental and Authorized Representative's Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in which poses potential health, safety or personal rights risk to persons in care.LPA reviewed children's file and observed that there are multiple children did not have a sign personal rights or parent rights. Licensee stated that, licensee might have lost it or have not received it back from the parents.
POC Due Date: 01/17/2023
Plan of Correction
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Licensee agreed to send signed personal right to LPA via email or text by end of day Tuesday (1/17/23) Licensee also agreed to send a letter to LPA stating how Licensee will make sure that this won't happen in the future.
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) 421-1324
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: 510-292-8297
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/12/2023 05:48 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: REED, ALICIA
FACILITY NUMBER: 013422117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care.LPA reviewed childrens file and observed that there are multiple children did not have a sign personal rights. .Licensee stated that, licensee might have lost it or have not received it back from the parents.
POC Due Date: 01/17/2023
Plan of Correction
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.LPA reviewed children's file and observed that there are multiple children did not have a sign personal rights or parent rights. Licensee stated that, licensee might have lost it or have not received it back from the parents.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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) 421-1324
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: 510-292-8297
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: REED, ALICIA
FACILITY NUMBER: 013422117
VISIT DATE: 01/12/2023
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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.

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.

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.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee.

5 type B deficiencies was cited in today’s visit.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: 510-292-8297
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5