013422829-6-19-2019-52-CC-LDYN-BDATL2-20190619144850

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422829
Report Date: 06/19/2019
Date Signed: 06/19/2019 02:48:54 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	RANDALL, PAMELA		FACILITY NUMBER:	013422829
ADMINISTRATOR:	RANDALL, PAMELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 213-5166
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY:	14	CENSUS: 3	DATE:	06/19/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Pamela Randall		TIME COMPLETED:	03:00 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 6/19/19 at 1:45pm Licensing Program Analyst (LPA) Loretta Dyson arrived at the home for an unannounced random inspection. LPA met with the licensee. There were 3 school age children also present. LPA toured all of areas of the home used for the child care, to conduct a health and safety inspection. The on limit areas include the living room, dining area, kitchen, hallway bathroom, and garage. The off limit areas are the bedrooms and the bathroom inside of the bedroom. These areas are made inaccessible by closed and/or locked doors and visual supervision. The isolation area will be a section of the living room, away from other children in care. The outdoor play area is the fenced backyard, which is free from defects or dangerous conditions. LPA observed an ample supply of toys and activities available for children, which are age appropriate and in good condition. LPA did not observe any bodies of water, hazardous items, or toxins accessible to children today. Per the licensee, there are no firearms in the home. There are gates to prevent access to the wall heaters, and there is no fireplace in the home. The licensee conducts and documents fire and earthquake drills at least twice a year, and the last drills conducted were on 4/19/19. The home has a working smoke detector, working carbon monoxide detector, fully charged 2A10BC fire extinguisher, first aid supplies and working telephone. At 2:14pm, LPA reviewed the file of 1 child in care. The licensee's CPR/first aid certificates are current and expire on 5/19/21. The facility roster was reviewed and a copy obtained. The licensee has a certificate of completion for the required mandated reporter training. LPA reminded the licensee that the mandated reporter training certificates are good for two years, and can be renewed at www.mandatedreporterca.com. Licensee was reminded of her responsibility as a mandated reporter. Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to sign up to receive quarterly updates by email by sending a request to ChildCareAdvocatesProgram@dss.ca.gov. continued 809C

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: RANDALL, PAMELA	FACILITY NUMBER: 013422829
	VISIT DATE: 06/19/2019

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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. The licensee stated that there are no children enrolled at this time, who require medication while in care.

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. LPA reviewed the individuals associated to the license, and the licensee confirmed that everyone who is required to have a criminal record clearance is associated.

The licensee is not caring for infants at this time, but LPA provided her with a copy of the Child Care Provider's Guide to Safe Sleep brochure for a reference if needed in the future.

There are no deficiencies being cited today. This report shall remain on file for 3 years. A Notice of Site visit was given to Licensee, and Licensee was reminded that it is required to be posted for 30 days. An exit interview was conducted with the licensee.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019

LIC809 (FAS) - (06/04)

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