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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422325
Report Date: 02/27/2020
Date Signed: 02/27/2020 12:52:16 PM

COMPREHENSIVE INSPECTION
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, LAURAFACILITY NUMBER:
013422325
ADMINISTRATOR:BULLOCK, LAURAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 672-5113
CITY:BERKELEYSTATE: CAZIP CODE:
94702
CAPACITY:14CENSUS: 12DATE:
02/27/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Licensee Laura BullockTIME COMPLETED:
02:30 PM
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On 02/27/2020, 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, her assistant S. Elbing, and her spouse J. White. Present for this visit was 12 preschool children.
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, 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, and cleaning compounds were observed out of reach of 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. At 12:30PM, LPA observed a 2A10BC fire extinguisher which was last serviced January 2020. At 12:34 PM, J. White tested the smoke and carbon monoxide alarm and it was found operable. 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 spouse, 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. Napping equipment was also observed to be stored properly to ensure no cross contamination. The home has two chickens and a cat.
Individual 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 but the facility does have an IMS plan in place. LPA received a copy of the IMS plan.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Brittany NewtonTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
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: 02/27/2020
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 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.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults 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 the training every 2 years.



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 spouse J. White due to licensee conducting circle time.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Brittany NewtonTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
LIC809 (FAS) - (06/04)
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