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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422280
Report Date: 01/10/2020
Date Signed: 01/10/2020 02:41:58 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:HAYES, YOLINDAFACILITY NUMBER:
013422280
ADMINISTRATOR:HAYES, YOLINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 470-8112
CITY:BERKELEYSTATE: CAZIP CODE:
94702
CAPACITY:14CENSUS: 0DATE:
01/10/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Yolinda HayesTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Brittany Newton met with Yolinda Hayes for an unannounced required random annual. There are no children present. The home was toured to conduct a health and safety inspection with the licensee.
The home is built like a duplex but is 1 address. The upstairs floor has 2 bedrooms, 1 bathroom, living room and a kitchen. The downstairs floor has 1 bedroom, 1 bathroom, living room, dining room and kitchen. The off limit area is the entire downstairs floor. Licensee states that there are no firearms. The isolation area for sick children is the living room. 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. The home has a 4A60BC fire extinguisher, smoke detector and carbon monoxide detector. The last fire drill was conducted 01/2020. The home is clean and orderly with heating and ventilation. Licensee provides snacks and sometimes dinner. Licensee takes the children to the neighborhood park for outdoor play. Toys are available in the home that are age appropriate. CPR and First Aid is current until 02/2020. Children records were found in compliance.

This facility is willing to provide Incidental Medical Services-IMS but currently doesn’t have anyone in care that is taking medicine. LPA discussed the need to create a plan of operation. 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.

A child care roster was unavailable for review. LPA Newton provided licensee with a copy of a child care roster. Licensee will send LPA a copy of the roster.

A guide to safe sleep pamphlet was given to licensee and LPA Newton discussed the importance of taking preventative measures.

No deficiencies observed at this visit. A Notice of Site visit was given and licensee was reminded that it is required to be posted for 30 days. Exit interview conducted and appeal rights provided, and a copy of this report was left with Yolinda Hayes.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Brittany NewtonTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
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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