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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423160
Report Date: 06/23/2022
Date Signed: 06/23/2022 12:36:47 PM


Document Has Been Signed on 06/23/2022 12:36 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, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:JOHNSON, CATHERINEFACILITY NUMBER:
013423160
ADMINISTRATOR:JOHNSON, CATHERINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 501-6955
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:14CENSUS: 7DATE:
06/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Catherine JohnsonTIME COMPLETED:
12:46 PM
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An unannounced Required - 1 Year inspection was conducted by Licensing Program Analyst L. Dyer. LPA arrived at the facility at 8:30 a.m. The licensee was present with 7 preschool-age children, 1 fingerprint cleared assistant, and one youth assistant. Facility is in compliance with licensed capacity and facility ratios. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall obtain a California clearance or criminal record exemption prior to working, residing or volunteering in a licensed facility. Phone number and e-mail address are current. Hours: 8:00 a.m. - 5:30 p.m.
At 9:00 a.m., the following was observed: The day care area of the home was inspected. Areas licensed for child care: bathroom, living room, dining room, bedroom, cubby room and kitchen. Off-limit areas will be made inaccessible to children by closed and/or locked doors; gates; and visual supervision. The home was clean and orderly, with adequate heating and ventilation. There were safe, healthful and comfortable accommodations, furnishings and equipment available to children at the time of this inspection. There were a variety of books and toys for children's use. Facility has functioning cell phone, smoke detector, carbon monoxide detector and fire extinguisher (2A:10:BC), Stairs and fireplace inside the home are gated. There are no hazardous materials, medicines, or cleaning solutions accessible to children during this inspection. Licensee will need to monitor children as they go to the bathroom as they will need to walk through the kitchen. Licensee stated there were no firearms or bodies of water on the premises. Back yard area is securely fenced. The back yard has 2 sections. The first section has a faux grass shaded area with riding toys, climbing toys, a slide, a tent, etc. The second section has a sandbox, a climbing area, a boat, a climbing wall, tables, chairs, a tire area, etc.
LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep web page 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. Licensee currently has no infants in care. (continued)
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis DyerTELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022
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: JOHNSON, CATHERINE
FACILITY NUMBER: 013423160
VISIT DATE: 06/23/2022
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Play yards were reviewed. Placement did not hinder the entrance or exit to and from the sleeping space. Mattresses were firm, sized appropriately, and were covered with a tightly fitted sheet. There are no objects hanging above or attached to the play yard, and no bumper pads. No pacifiers were seen Licensee states sheets are replaced when soiled or wet, and individual bedding is only used by one child only. Soiled bedding is placed in a closed container and is inaccessible until washed. Bedding is washed weekly.
LPA reviewed facility, children's and personnel records at 10:44 a.m. Licensee's Mandated Reporter Training expires 4/16/24. Licensees' CPR/First Aid expires March, 2023. Last disaster drill completed on 4/19/22. Files are complete and all required postings are visible for public review. Facility roster was current.
Licensee 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 maximum per day/per person will be assessed if this regulation is violated. Licensee was also reminded of the Department's Inspection authority, and the need to comply when notified that termination of an employee is necessary.
Also discussed with the licensee: supervision of children at all times; car seats and high chairs; Unusual Incident Reporting; advertisements; changes in on-limit areas; construction work at facility; paying fees on-line; smoking; ill children in home, and the Guardian background check process. A qualified assistant must be physically present whenever 9 or more children are in care. When an assistant is not present, the home reverts back to small family child care ratios.
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.

NO DEFICIENCIES CITED TODAY.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Catherine Johnson.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis DyerTELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC809 (FAS) - (06/04)
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