013423434-1-24-2024-52-CC-LDBX-CZSRJB-20240124120341

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423434
Report Date: 01/24/2024
Date Signed: 01/24/2024 12:03:50 PM

Document Has Been Signed on 01/24/2024 12:03 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	BERRY, MARIE LINDA		FACILITY NUMBER:	013423434
ADMINISTRATOR:	BERRY, MARIE LINDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 750-7680
CITY:	PLEASANTON	STATE: CA	ZIP CODE:	94588
CAPACITY:	14	CENSUS: 11	DATE:	01/24/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Katelyn Marin		TIME COMPLETED:	12:20 PM

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On 01/24/2024 Licensing Program Analyst (LPA) Lorraine Dacanay Breaux, met with fingerprint and TB cleared staff Katelyn Marin for an UNANNOUNCED ANNUAL INSPECTION. Present for the inspection two (2) fingerprint cleared assistants and eleven (11) toddler age daycare children. Two ABA was present during today's visit. Upon arrival LPA provided assistant a copy of the Entrance Checklist (LIC 126). Staff interview was completed. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday - Friday 06:30 AM - 5:30 PM. Facility provides care for children starting at 2 years of age.

The home is a single story home with 4 of bedrooms, 2 bathrooms, living room, family room, kitchen with dinning area, laundry room, garage, 3 sheds back yard with locks. The home appears to be neat and clean with central heating and ventilation for safety and comfort. The home does have a fireplace in the living room that is screened to prevent access to children. During today's visit the weather conditions did not allow the LPA to completely inspect the rear yard. .

ON-LIMIT AREAS: Family room (front of the home), living room, dining room, and the main bathroom in the hallway, and the rear yard which is fully fenced. The office (room across from the family room with glass double doors is used when a child is ill.

OFF-LIMIT AREAS: All bedrooms which includes the master bedroom and bathroom, and the garage. Off limit areas and will be inaccessible to children by locked doors, safety gates and visual supervision. Isolation Area: Office (room right of the front door with the glass double doors) away from the children in care, until the parents arrive.

All hazardous materials and toxins are kept out of reach from children and are not accessible. The home has a fully charged 3A40BC fire extinguisher located in the kitchen, working smoke detector(tested), carbon monoxide detector(tested), telephone and fully stocked first aid kit. There are no pools, hot tubs or any other bodies of water present at the time of the inspection. Per assistant, there are no firearms on the premises.

Page 1 of 3 ***Continued on LIC 809C***

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BERRY, MARIE LINDA	FACILITY NUMBER: 013423434
	VISIT DATE: 01/24/2024

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The licensee completed the Health and Safety training, CPR/First Aid certification expires on 02/17/2025. The licensee is in compliance with the immunization laws. Licensee is reminded of their responsibility to renew CPR/First Aid and Mandated Reporter certificates every two years. The licensee conducts and documents fire and disaster drills twice a year and the last conducted drill was on 12/05/2023. All required forms are posted and visible for public review.

Records: At approximately 10:40 AM LPA requested and reviewed six (6) children’s files and three (3) personnel files. LPA requested the facility and children's roster copy obtained. Staff interview also conducted and documented.

Provider Information Notices (PINs) & Quarterly Updates: Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders, by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email notifications.

Criminal Record Clearance: 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.

MyChildCarePlan.org: 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.

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SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BERRY, MARIE LINDA	FACILITY NUMBER: 013423434
	VISIT DATE: 01/24/2024

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Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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/resources/child-care-centers/.

Megan’s Law: During the exit interview, the facility representative, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Unusual Incident/Student Injury Report: Effective August 1, 2003 California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 business days.

No deficiencies issued during today's inspection. ONE advisory note is being issued today. Advisory notes are not citations:

·Advisory Note (TV): Licensee and Staff S. Wadsworth Mandated Reporter training is expired. BOTH licensee and assistant will complete in five (5) consecutive days due on 01/29/2024. Both copies will be emailed to LPA.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights. Exit interview conducted and report was reviewed with the facility representative, Katelyn Marin.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC809 (FAS) - (06/04)

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