013423524-6-16-2021-02-CC-DCAS-C42QUE-20210616122836

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423524
Report Date: 06/16/2021
Date Signed: 06/16/2021 12:28:41 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:	THORNTON, MONTRAE		FACILITY NUMBER:	013423524
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	06/16/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Montrae Thornton		TIME COMPLETED:	12:45 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	On 06/16/2021, Licensing Program Analyst (LPA), Diana Campos conducted an in-person case management/increase in capacity inspection. Present during today's inspection was the licensee. Licensee's fiancee and 6 children in care were present during this inspection. The entire home was toured to conduct a health and safety inspection with licensee. Hours of operation for day care are Monday through Saturday, 6:00am to 5:00am. Community Care Licensing (CCL) has received an approved fire clearance. This is a single story home which consists of a living room, dining area, kitchen, three bedrooms, two bathrooms, back yard and attached garage. The on-limit areas are: the living room, dining area, the first two bedrooms in hallway next to bathroom, the bathroom in the hallway and the back yard. The Off limit areas are the bedroom and bathroom next to the back door and the attached garage. Off limit areas will be made inaccessible by use of gates, closed and/or locked doors and visual supervision. The fenced backyard will be used as the outdoor play area. Licensee was advised to call licensing before using any off-limits areas for day care children. There are age appropriate toys in the home. There are no firearms in the home as stated by the licensee. LPA did not observe any hazardous materials or toxins accessible to children today. The home has a fully charged 3 A 40 BC fire extinguisher. The home is equipped with working smoke detectors and carbon monoxide detector. There is a working telephone in the home. The applicant’s CPR and First Aid certificate is current and expires 05/28/2023. Licensee completed mandated reporter training. Licensee is in compliance with immunization requirements. Safe sleep information was discussed with the licensee. Safety precaution in regards to COVID-19 were discussed and (posters were posted on front door). See 809-C for continuance.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana Campos	TELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

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: THORNTON, MONTRAE	FACILITY NUMBER: 013423524
	VISIT DATE: 06/16/2021

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The licensee was 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. The applicant was reminded of the responsibility as a mandated reporter.

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

A required annual inspection was also conducted during today's visit.

No deficiencies observed at this visit.

The licensee is now approved for a increase in capacity to operate as a large family day care home. A Notice of Site visit was given and licensee was reminded that it is required to be posted for 30 days. Exit interview conducted and appeal rights provided, and a copy of this report was left with licensee's assistant Maria Hall.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana Campos	TELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

LIC809 (FAS) - (06/04)

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