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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423493
Report Date: 04/21/2022
Date Signed: 04/21/2022 01:49:35 PM


Document Has Been Signed on 04/21/2022 01:49 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:CLARK, THOMEIKA & KNOX, SHELTONFACILITY NUMBER:
013423493
ADMINISTRATOR:CLARK, THOMEIKA & KNOX, SHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
5108276071
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:14CENSUS: 8DATE:
04/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Thomeika ClarkTIME COMPLETED:
01:56 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 9:30 a.m. Licensees were present with 8 day care children (1 infant and 7 preschool-age). 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: 7:30 a.m. - 5:30 p.m. The day care area of the home was inspected. Areas licensed for child care: living room, dining room, bathroom and baby room. The baby room is currently being used for storage. Off-limit areas will be made inaccessible to children by closed and/or locked doors; gates; and visual supervision.
At 9:50 a.m., the following was observed: 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 (3A:40:BC). Fireplace was screened. Hazardous items are kept in the bathroom on high shelves, inaccessible to children. Licensee stated there were no firearms or bodies of water on the premises.
Back yard area is securely fenced. Licensee has a trampoline, riding toys, a slide, and other outdoor toys for child play. There is a swing set that children are not allowed to play on as it is not safe for child play. LPA pointed out to the licensee that the round liner on the trampoline will need to be replaced. Licensee also has a rosebush outside and was requested to take extra care when children are in this area.
LPA discussed the safe sleep regulations with the licensee representative] and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licening/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 (continued)
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis DyerTELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2022
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: CLARK, THOMEIKA & KNOX, SHELTON
FACILITY NUMBER: 013423493
VISIT DATE: 04/21/2022
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their purchased equipment. Also given and discussed: Infant Individual Sleeping Plans. Licensee currently does not have any infants in care.
Play yards were viewed. Licensee does not allow pacifiers at the facility. Older children sleep on cots. Licensee states sheets are replaced when soiled or wet, and individual bedding is only used by one child only. Bedding is washed.
LPA reviewed facility, children's and personnel records at 10:34 a.m. Licensees' Mandated Reporter Training expires 4/25/22. Licensees' CPR/First Aid expires 6/16/22. Last disaster drill completed on 2/11/22. All 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; children are not to be left in parked vehicles; 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 new 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.

Important E-mail Addresses:
Community Care Licensing General Information and Updates:www.ccld.ca.gov. For updates, click the "Receive Important Updates" box.
Mandated Reporter Training: www.mandatedreporterca.com (Child Care Providers Module - required every 2 years). (continued)
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis DyerTELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022
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: 04/21/2022
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Alameda County Public Health Department Website: www.acphd.org
Guardian: background check process with self-service options: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

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

DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022
LIC809 (FAS) - (06/04)
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