013423493-1-21-2020-02-CC-PDYR-BL33NX-20200121172439

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423493
Report Date: 01/21/2020
Date Signed: 01/21/2020 05:24:45 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:	CLARK, THOMEIKA & KNOX, SHELTON		FACILITY NUMBER:	013423493
ADMINISTRATOR:	CLARK, THOMEIKA & KNOX, SH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 827-6071
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94605
CAPACITY:	14	CENSUS: 6	DATE:	01/21/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Thomeika Clark and Shelton Knox		TIME COMPLETED:	05:30 PM

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	An unannounced Annual/Random inspection was conducted by LPA Dyer. The licensees were present with 6 day care children (1 infant, 3 preschool-age and 2 school-age). Licensees were in compliance with the licensed capacity and facility ratios. Phone number is current. Hours: 6:00 a.m. - 5:30 p.m. The day care area of the home was inspected. Areas licensed for child care: living room, dining room, baby room and the bathroom. Off-limit areas will be made inaccessible to children by closed and/or locked doors; gates; and visual supervision. All required forms are posted or were given to post for public review. There was a working smoke detector (tested); a fully charged 3-A:40-B:C fire extinguisher; a first aid kit, and a carbon monoxide detector. 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. Fireplace was blocked and screened. There are no hazardous materials, medicines, or cleaning solutions accessible to children during this inspection. Hazardous items are kept on high shelves, inaccessible to children. Licensee stated there were no firearms or bodies of water on the premises. Children nap on mats and in cribs. Bedding is sent home weekly to be laundered by parents. Back yard area is securely fenced. Children have not played outside recently due to rainy weather. At 4:40 p.m., a sample of children's files were reviewed. All have emergency information in file. Licensee is conducting and documenting fire drills and utilizing the child care roster. 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. (continued)

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

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: CLARK, THOMEIKA & KNOX, SHELTON	FACILITY NUMBER: 013423493
	VISIT DATE: 01/21/2020

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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.

All staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee's Pediatric First aid and CPR cards expire June 2020.

Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children, or an immediate civil penalty can be assessed. 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.

Licensee has required immunizations in file, and her Mandated Reporter Training expires 3/21/2020. Mandated Reporter training is free and is available at www.mandatedreporterca.com (Child Care Provider Module).

Licensee was also reminded of the Department's Inspection authority, and the need to comply when notified that termination of an employee is necessary. The handout, "A Child Care Provider's Guide to Safe Sleep" was provided and discussed in detail at the last inspection and reviewed again today. Also discussed with the licensee: children in parked vehicles; substitutes; fingerprinting/association; advertisements; changes in on-limit areas; construction work at facility; paying fees on-line and smoking. Licensee was encouraged to frequently visit the licensing website at www.ccld.ca.gov for licensing regulations, forms and updates.

For CCL Updates, go to www.ccld.ca.gov. Click the "Receive Important Updates" box. Enter your e-mail address.

NO DEFICIENCIES CITED TODAY.

Notice of site visit must be posted for 30 days. An exit interview was conducted. This report must be available for public review for 3 years.

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

LIC809 (FAS) - (06/04)

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