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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422620
Report Date: 03/18/2022
Date Signed: 03/18/2022 12:54:31 PM

Document Has Been Signed on 03/18/2022 12:54 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:REYNOLDS, CASSANDRAFACILITY NUMBER:
013422620
ADMINISTRATOR:REYNOLDS, CASSANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 858-8666
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
03/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cassandra ReynoldsTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lorraine Dacanay Breaux conducted an unannounced 1 year required ANNUAL/RANDOM inspection. Present during today’s inspection was the licensee, finger print cleared husband, two fingerprint cleared assistants, and 6 (six) children in care. Hours of Operation Monday - Friday 8:00 AM - 3:30 PM.

The home was toured for Health and Safety Inspection. This is a single story home with a kitchen, dining room, family room, three bedrooms and two full bathrooms and a garage. On limit areas: consists of the entire home, dining room/family room, kitchen, all bedrooms, including the master bedroom and bathroom and front/rear yard. LPA Breaux inspected and added the master bathroom effective today, March 18, 2022. Off limit areas: Garage per fire safety inspection (dated 12/21/2017). The rear yard is fully fenced. There are no pools, spas, hot tubs, or any other similar bodies of water at this home. There are no firearms on the premises as stated by the licensee. The fireplace is screened to prevent access by children. LPA verified that the fire extinguisher is fully charged. The home is equipped with dual smoke detector and carbon monoxide detector. There is a working telephone in the home. The home provides appropriate toys, learning materials and play equipment. Outdoor play area is fenced. The licensee is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Licensee is reminded not to use the garage as per Fire Department.

The licensee was reminded that children are not to be left in parked vehicles. Safe Sleep booklet and safe sleep practices was provided and discussed with licensee. No medication being administered at this time. LPA did not observe any hazardous materials or toxins accessible to children today. Knives, cleaning supplies, and medication were stored out of reach of children. Disaster/fire drill was conducted on 10/12/2021.

6 (six) children files were reviewed and staff files reviewed contain children’s emergency information. Children's roster was reviewed and a copy obtained.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: REYNOLDS, CASSANDRA
FACILITY NUMBER: 013422620
VISIT DATE: 03/18/2022
NARRATIVE
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://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 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.
The licensee is reminded 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 Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.

Licensee [or facility representative] 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.

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/inspection-process.

There was deficiencies issued today. See LIC 809D for details. The report will remain on file for three years.

A notice of site visit was given and must remain posted for 30 days.



Exit interview conducted and report was reviewed with the licensee Cassandra Reynolds.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
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Document Has Been Signed on 03/18/2022 12:54 PM - It Cannot Be Edited


Created By: Lorraine Dacanay-Breaux On 03/18/2022 at 12:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: REYNOLDS, CASSANDRA
FACILITY NUMBER: 013422620

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.3(a)(1)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (1) Conversion of a garage (either attached or detached) into a "child care" room.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above for licensee which poses an immediate health, safety or personal rights risk to persons in care.

POC Due Date: 03/18/2022
Plan of Correction
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Children was removed from the garage. Licensee reminded not to use off limit areas. Garage is off limits per Fire Department.
Type A
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above for licensee which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/25/2022
Plan of Correction
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Children was removed from the garage. Licensee reminded not to use off limit areas. Garage is off limits per Fire Department. Licensee will submit a letter to licensing by March 25, 2022 indicating that she understands and will not use off limit areas for children in care.
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:Chandra Charles
LICENSING EVALUATOR NAME:Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2022


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