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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422266
Report Date: 01/30/2020
Date Signed: 01/30/2020 03:09:03 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:ANDERS, AKIVAFACILITY NUMBER:
013422266
ADMINISTRATOR:ANDERS, AKIVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 529-4241
CITY:BERKELEYSTATE: CAZIP CODE:
94702
CAPACITY:14CENSUS: 0DATE:
01/30/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Akiva AndersTIME COMPLETED:
04:00 PM
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On 01/30/2020, Licensing Program Analyst (LPA) Brittany Newton made an unannounced visit for the purpose of conducting a required annual inspection. LPA was met by licensee Akiva Anders. No children are in care at the moment due to licensee operating half days until September 2020. The home was toured to conduct a health and safety inspection.

The home is a one story home. The home consists of a living room, dining room, kitchen, 2 bedrooms, 2 bathrooms, unfenced front yard, fenced back yard and converted garage. The converted garage is used for a play room and is the main area of the day care. Licensee states there are no firearms. The isolation area is the second bedroom. There are no pools, spas, hot tubs, fish ponds or similar bodies of water. All poisons, detergents, cleaning compounds and medications are stored in areas which are inaccessible to children. There are no fireplaces or open face heaters accessible to children. The home has a 2A10BC fire extinguisher and a combination smoke and carbon monoxide detector. Fire and Disaster Drills are conducted every week due to the licensee going to a movement class with the children, the last one was 01/21/2020. Outdoor play area was inspected for hazards and found to be in compliance and free from any. A chicken coop is in the backyard with two chickens. CPR and First Aid certificates are current and expire on 07/2020.

LPA reviewed children files which were found in compliance. Licensee requested LPA to update license to reflect hours of operation as Monday through Friday, 8:00AM until 1:30PM. This will be in effect until September 2020, which Licensee will notify LPA when they would like to go back to extended hours of care.

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 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: Sherelle JohnsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Brittany NewtonTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2020
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: ANDERS, AKIVA
FACILITY NUMBER: 013422266
VISIT DATE: 01/30/2020
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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 and the requirement to complete it every two years. Licensee completed the training 01/02/2020.

Licensee will send LPA Newton the child care roster. 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.

No deficiencies observed at this visit. 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 Akiva Anders.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Brittany NewtonTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2020
LIC809 (FAS) - (06/04)
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