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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423298
Report Date: 12/09/2019
Date Signed: 12/09/2019 01:04:00 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:HART, LAWRENCEFACILITY NUMBER:
013423298
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 1DATE:
12/09/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Lawrence HartTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst met today with Susan Neeson met with Lawrence Hart, LIcensee. for an unannounced random annual inspection at 8:30 AM. There is one preschool child present. Lawrence Hart states that he resides here by himself. Also present is his fingerprinted assistant.

The home is two stories. The downstairs consists of of a living room, play room, dining area, kitchen and 1/2 bath. All areas are used by day care children. Upstairs consists of 4 bedrooms and a full bath. All of the upstairs is off-limits. The yard is also off-limits. The shed in the yard is off-limits. Children are taken to nearby parks for outside play. There is a small laundry room in the on main level. The laundry room has a secure barricade. The stairs are also securely barricaded,

Children's records were reviewed. Staff records were reviewed. The home has a currently charged fire extinguisher, one working smoke alarm and a working carbon monoxide alarm. All hazardous items are stored up high or locked up and inaccessible. The fireplace in the living room has a secure barricade. The home has central heat. The home is clean and orderly. There are ample toys and equipment for children in care. The children use the half bath. It contains no hazards. The family has no pets. There are no bodies of water. Forms which need to be posted were discussed. LIC 311 D was issued.

Lawrence Hart states that there are no guns or firearms in the home, the shed outside or other storage areas.
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 and for day care updates visit www.myccl.ca.gov
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan NeesonTELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2019
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 3
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: HART, LAWRENCE
FACILITY NUMBER: 013423298
VISIT DATE: 12/09/2019
NARRATIVE
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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 following documents were issued and discussed: Capacity sheet for large license, blue immunization forms, Flu prevention information, Quarterly update from Department, AB 1207 information, Safe Sleep for infants, Fire/earthquake drill information, Safe and healthy diapering, Parents Rights, Licensee rights & items not allowed in FCCH. Safe sleep for infants was discussed at length.



Copy of roster was requested. Blank forms for increase in capacity were issued.

Deficiencies are cited on 809 D.

Appeal Rights were discussed.

An exit interview was given.
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan NeesonTELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: HART, LAWRENCE
FACILITY NUMBER: 013423298
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/30/2019
Section Cited

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Personnel Requirements(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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This was not met in that S 1 & S 3 lacked proof of current CPR and First Aid.
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Type B
12/30/2019
Section Cited

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Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.

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This was not met in that there are no records of fire/earthquake drills being done and documented.
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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: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan NeesonTELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3