013422280-3-23-2023-02-CC-ILOA-CQ7RVD-20230323132121

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422280
Report Date: 03/23/2023
Date Signed: 03/23/2023 01:21:28 PM

Document Has Been Signed on 03/23/2023 01:21 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	HAYES, YOLINDA		FACILITY NUMBER:	013422280
ADMINISTRATOR:	HAYES, YOLINDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 470-8112
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94702
CAPACITY:	14	CENSUS: 2	DATE:	03/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:48 AM
MET WITH:	Yolinda Hayes		TIME COMPLETED:	01:32 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	On March 23, 2023 at 11:48am Licensing program Analyst (LPA) Indira Loza arrived at the facility to conduct an annual random inspection. Present for the inspection were the Licensee, and two preschool age children. The home was inspected to conduct a Health and Safety check. Operating hours are Monday through Friday 7:00am to 7:30pm. The home is built like a duplex but is one address. The upstairs floor has two bedrooms, one bathroom, living room and a kitchen. The downstairs floor has one bedroom, one bathroom, living room, dining room kitchen, and a fenced in front yard. The child care area is on the upper level of the house which are the living room, dining room, one bedroom, and bathroom. The off limit areas are the back bedroom, the kitchen, and the entire bottom floor of the house. The on limit areas are the living room, dining room, bathroom, front bedroom, and the front yard. The Licensee’s Pediatric CPR and First Aid training has been completed and expires on April 20, 2024. LPA obtained the children’s files for review and the children's roster. Last Fire Drill was conducted March 23, 2023. The Licensee provides breakfast, lunch, and one snack. The home was observed to be neat and clean with ample age appropriate toys. The front yard is used for outside play and is fully enclosed with age appropriate toys and activities for the children. LPA observed the home to have heat and ventilation for the comfort of children. Per Licensee there are no firearms in the home. The Licensee has Liability Insurance. There was a 4A60BC fire extinguisher in the home. LPA observed a working carbon monoxide and smoke detector. Licensee was reminded that California Law requires Licensee to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com. ***********************Report Continues on LIC809-C*******************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

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: HAYES, YOLINDA	FACILITY NUMBER: 013422280
	VISIT DATE: 03/23/2023

NARRATIVE

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Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. The Licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02 CCP. 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.

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/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 athttps://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
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.
************************Report Continues on LIC809-C*****************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 03/23/2023 01:21 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: HAYES, YOLINDA	FACILITY NUMBER: 013422280
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/23/2023

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
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above as the Mandated Reporter Course was not complete which poses a potential health, safety or personal rights risk to children in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	The Licensee shall email the LPA a copy of a completed Mandated Reporter Certificate no later than April 28, 2023.

Type B

Section Cited

CCR

102421(b)

Child's Records

(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in one of two children files reviewed was missing an emergency card which poses a potential health and safety or isk to children in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	The LIcensee shall email the LPA a copy of a completed Emergency Information Card (LIC 700) no later than April 28, 2023.

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: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

LIC809 (FAS) - (06/04)

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