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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422680
Report Date: 01/10/2020
Date Signed: 01/10/2020 02:55:00 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:LYONS, MARVAFACILITY NUMBER:
013422680
ADMINISTRATOR:LYONS, MARVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 521-3997
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY:14CENSUS: 7DATE:
01/10/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Marva LyonsTIME COMPLETED:
03:00 PM
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Licensing Program Analysts Arminder Singh and Monica Mathur met with Licensee, Marva Lyons for an unannounced random annual inspection at 01:30PM. Present during the inspection was the licensee's 16 year old assistant. All adults are finger print cleared. There are 7 children present (one infant, four preschoolers, two school aged children). Children's records (C1-C5) was reviewed by the LPAs at 2:05PM. C1-C5 files are complete. The Licensee stated that there are no additional records available in the facility. The home was toured to conduct a health and safety inspection.

The home is a one story home on an elevated level with a garage below that is used by the landlord only and licensee does not have permission to access. The home consists of a living room, dining room, kitchen, 2 bedrooms, and 1 bathroom. The ON LIMIT AREAS are the living room, family room and bathroom. The remainder of the home is OFF LIMIT AREAS which will be inaccessible by closed and/or locked doors and visual supervision. The outdoor play area is the local park and requires 100% supervision. ISOLATION AREA is the entrance part of the home. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today.
The home has a fully charged 2A10BC fire extinguisher, working smoke detector, and carbon monoxide detector. There is centralized heating that is working and in good repair. Licensee states there are no firearms in the home. Her Pediatric CPR and First Aid certificates are current and expire on September 2021. She has a first aid kit. Licensee is in ratio today
Please see LIC 809 C for additional information.
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
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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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: LYONS, MARVA
FACILITY NUMBER: 013422680
VISIT DATE: 01/10/2020
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This facility is not providing Incidental Medical Services - IMS at this time. LPA discussed IMS services and the requirement to create a plan of operation. Specifics on the plan can be found in the family child care home evaluator manual.


REMINDERS/RESOURCES
· Criminal Background Clearance: All assistants, volunteers, frequent adult visitors (adults are individuals 18 years of age or older) must be fingerprint cleared and associated to the facility prior to be in the presence of children in care. Failure to comply, requires an immediate civil penalty of $100 to $3000 per person, per incident.

· CCLD Complaint Hotline, 1-844-LET-US-NO (1-844-538-8766) email: LetUsNo@dss.ca.gov

· NEW LAW: Safe Sleep Regulations: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep

· Licensees and all staff are Mandated Reporters and are required to report to CCLD any suspected child abuse.

CCLD website address for obtaining licensing forms, training videos and other provider resources can be obtained at www.ccld.ca.gov


There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
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
LIC809 (FAS) - (06/04)
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