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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423319
Report Date: 08/16/2024
Date Signed: 08/16/2024 11:23:16 AM


Document Has Been Signed on 08/16/2024 11:23 AM - 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:TOYOZUMI, YUKIFACILITY NUMBER:
013423319
ADMINISTRATOR:TOYOZUMI, YUKIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 213-3441
CITY:BERKELEYSTATE: CAZIP CODE:
94705
CAPACITY:14CENSUS: 0DATE:
08/16/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Yuki ToyozumiTIME COMPLETED:
11:40 AM
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On 8/16/2024 at 8:30 AM Licensing Program Analysts (LPAs) Kareeca Sykes and Diana Campos conducted an unannounced Annual Random inspection at Yuki Toyozumi Family Childcare Home. LPAs met with Yuki and explained the purpose of today's inspection. LPAs were granted the inspection authority to enter the Home. The family childcare home days and hours of operation are Monday, Wednesday 2:00PM-5:45PM, Thursday and Friday 02:30 PM to 05:45 PM. Present in the home at time of inspection were Licensee and her fingerprint cleared husband.

Indoor Space: A health and safety tour of inside the home was done. LPAs toured the premises with licensee. The home is a two story house consisting of 4 bedrooms, 3 bathrooms, entry way, living room, dining room, kitchen and a converted office. The home is sanitized and orderly in compliance with Title 22 Regulations during today's inspection, with heating and ventilation for the safety and comfort of children in care.


Outdoor Space: The back yard is off limits to day care children, instead the licensee states children are taken to the park located directly across the street from the home for outdoor activities. LPAs toured the outdoor area (backyard) and observed it was fenced. LPAs observed there is a fish pond in the back yard (off limit area) which is covered by netting.
OFF-LIMIT areas are the entire upper level, the office and the back yard. LPAs observed these areas are inaccessible to children in care today by closed locked doors and visual supervision.
IN-USE The entry way, the living room, dining room, kitchen, and bathroom on the first level is used as the primary areas for day-care.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2024
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: TOYOZUMI, YUKI
FACILITY NUMBER: 013423319
VISIT DATE: 08/16/2024
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Medicines, cleaning products, and sharp objects are stored inaccessible to children in care during today's inspection. The fireplace is blocked to prevent access by children in care. The home maintains a working telephone. Licensee was reminded that smoking is not allowed in a family child care home. Licensee was reminded that baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. There is one dog in the home. Licensee stated there are no arms or ammunition stored in the home. There is a 2A10BC fire extinguisher, smoke and carbon monoxide detector in the home. Children files and Facility files were reviewed. Facility contained a Children's Roster, Licensee’s mandated reporter training expires 10/2025, pediatric CPR and first aid expires 11/2025.
To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, confirmed that there are no Registered Sex Offenders living in the facility and.

A notice of site visit was given and must remain posted for 30 days.

No deficiencies cited today.

Exit interview conducted and report was reviewed with the licensee Yuki Toyozumi.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
LIC809 (FAS) - (06/04)
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