013423541-12-20-2019-02-CC-JCHN-BK2Q3K-20191220104852

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423541
Report Date: 12/20/2019
Date Signed: 12/20/2019 10:49:01 AM

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:	YOUNG, ARTENSIA		FACILITY NUMBER:	013423541
ADMINISTRATOR:	YOUNG, ARTENSIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 552-1710
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94605
CAPACITY:	14	CENSUS: 7	DATE:	12/20/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Artensia Young		TIME COMPLETED:	11:00 AM

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	Licensing Program Analysts Caroline Colson and Junell Chen met with Artensia Young, applicant and her assistant, Nicole Charles for a change of location announced prelicensing inspection at 9:00 AM. There are two infants and five preschool children. The home was toured to conduct a health and safety inspection. LPAs discussed immunization records, mandated reporting requirements, nutritious beverage law and incidental medical services. All required forms were reviewed and discussed.. Ms. Young was informed of the new civil penalty assessments of up to $500 per adult during the initial inspection for not having cleared fingerprints on file (if needed) before contact with the day care children. The home is a one story home. The home consists of a living room, kitchen, two bedrooms, one walk in closet, locked shed, unfenced front yard, fenced backyard, driveway, and walk way on the left side of home. The off-limit areas are the master bedroom with walk in closet, locked shed, and walk way on the left side of the home. There is a 2A10BC fire extinguisher, a working smoke detector and working carbon monoxide detector. Ms. Young states that there are no firearms in the home. There are toys available. She will use her fenced back yard and driveway for outdoor play. During outdoor play, Ms. Young must provide visual supervision at all times. The isolation area will be the first bedroom . There are no pets. Her pediatric CPR and First Aid certificates are current and expire on August 18, 2021. Ms. Young has a first aid kit available. This facility is not providing Incidental Medical Services-IMS at this time. LPAs discussed IMS services and the requirement to create a plan of operation. Specifics on the plan can be found in the family child care home evaluator manual (FCCH) Policy 102417. Records were reviewed. LPAs discussed the process regarding change of location application. Safe sleep practices were discussed with Applicant. Please See LIC 809 C for additional information.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Junell Chen	TELEPHONE: (510) 622-4035
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019

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: YOUNG, ARTENSIA	FACILITY NUMBER: 013423541
	VISIT DATE: 12/20/2019

NARRATIVE

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The following corrections will need to be completed by January 20, 2020:

1. Applicant needs to make all Aloe Vera plants located in the back yard and driveway inaccessible to children.
2. Applicant needs to ensure that all debris is removed from the fenced back yard.

An exit interview was conducted. Appeal rights were given and discussed. This report must be available for public review for 3 years.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Junell Chen	TELEPHONE: (510) 622-4035
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019

LIC809 (FAS) - (06/04)

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