013422829-2-6-2020-52-CC-EWOS-BLJNFA-20200206092513

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422829
Report Date: 02/06/2020
Date Signed: 02/06/2020 09:25:18 AM

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: 0	DATE:	02/06/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Pamela Randall		TIME COMPLETED:	09:45 AM

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 02/06/2020, at approximately 8:00 AM, Licensing Program Analyst (LPA) Elimika Woods met with licensee Pamela Randall for an unannounced 1 YEAR REQUIRED visit. Present for this inspection was licensee's finger print cleared daughter, R. Randall. The home was toured to conduct a Health and Safety Inspection. The facility currently plans to operate 7:00 AM until 7:00 PM., Monday through Friday On-limit-areas include: Living room, dining area, bathroom, and kitchen Off-limit-areas include: All bedrooms, backyard, garage This single story home, which is neat and clean with sufficient heating and ventilation for safety and comfort. The ISOLATION AREA will be a section of the living room away from children in care. The off-limit areas will be inaccessible by child safety gates, closed and/or locked doors and visual supervision. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today's inspection. There are ample age appropriate toys, learning materials, and equipment that appears to be safe and in good condition. LPA did not observe any other bodies of water, hazardous materials, or toxins accessible to children on the premises during today’s inspection. The home has a fully charge 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone and First Aid Kit. The licensee’s Health and Safety training is completed, and CPR and First Aid certificate is current and expires 05/19/21. The licensee is in compliance with the immunization laws which pertains to all day care providers. The facility roster was reviewed, and copy obtained. The fireplace is blocked to prevent access to children. Per licensee, there are no firearms in the home. The licensee conducts and documents Fire/Disaster Drills at least twice a year, and the log indicates a drill was conducted 11/18/2019. All required licensing documents are posted and visible for public review. *Continued on LIC 809C*

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: 02/06/2020

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
26
27
28
29
30
31
32

At 9:00 AM LPA Woods requested to review two (2) children’s facility files. Each file contained completed Identification & Emergency forms, Personal Rights and Completed Medical consent forms.

Incidental Medical Services (IMS) -Per the licensee, there are no children on any form of medication. The licensee is not providing IMS currently.

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. All forms can be downloaded at www.ccld.ca.gov

CPR/First Aid is to renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. LPA discussed Unusual Incidents Reports.

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. LPA Woods provided a copy of the new California Car Seat Law Changes.

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list

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: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2