013422325-1-28-2020-02-CC-BNEN-BL9S4W-20200128123325

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422325
Report Date: 01/28/2020
Date Signed: 01/28/2020 12:33:30 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:	BULLOCK, LAURA		FACILITY NUMBER:	013422325
ADMINISTRATOR:	BULLOCK, LAURA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 672-5113
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94702
CAPACITY:	14	CENSUS: 12	DATE:	01/28/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Licensee Laura Bullock		TIME COMPLETED:	01:30 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 01/28/2020, Licensing Program Analyst (LPA) Brittany Newton made an unannounced visit for the purpose of conducting a required annual inspection. LPA was met by licensee Laura Bullock. Present for this visit was 12 preschool children, the licensee’s husband, and assistant S. Elbling. 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, dinning room, kitchen, 3 bedrooms, 1 bathroom, a laundry room area, a closet, a deck attached to the fenced back yard, garden, unfenced front yard, shed and garage. The off limit areas are the 2 bedrooms, front yard and shed. The licensee operates the day care in the backyard, the art room which is a converted garage in the backyard, the living room in the house, and the play room in the house. 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 is clean and orderly with heating and ventilation. All required forms are posted. The isolation area is the bedroom down the hall from the bathroom. First Aid Kit is available and complete. There is a 2A10BC fire extinguisher and a working smoke and carbon monoxide alarm. The licensee has been conducting fire drills, with the last one being 12/19/19. CPR and First Aid is current for the licensee and husband, expiring 03/09/2021. The fenced outdoor play area is used for activities for the children. The licensee has liability insurance. The licensee provides snacks, LPA Newton reviewed storage of food and found it in compliance. Napping equipment was also observed to be stored properly to ensure no cross contamination. The home has two chickens and a cat. Children files were reviewed and found to be in compliance. Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. Currently, no children in care require administration of medicine. LPA Newton consulted with Licensee about the plan of operation and the LIC 9221 for the consent of administration that would be needed if and when a child in care needs 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:

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Brittany Newton	TELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020

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: BULLOCK, LAURA	FACILITY NUMBER: 013422325
	VISIT DATE: 01/28/2020

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Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

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 completed every two years.

A copy of the child care roster was obtained.

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, appeal rights provided, and a copy of this report was left with licensee Laura Bullock.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Brittany Newton	TELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020

LIC809 (FAS) - (06/04)

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