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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423548
Report Date: 01/26/2024
Date Signed: 01/26/2024 04:55:01 PM

Document Has Been Signed on 01/26/2024 04:55 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:HILL-WALLACE, TRINA & HILL, SHIRLEYFACILITY NUMBER:
013423548
ADMINISTRATOR:HILL-WALLACE, TRINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 500-6504
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 8DATE:
01/26/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Trina Hill-WallaceTIME COMPLETED:
05:05 PM
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On 1/26/2024 at 1:45PM Licensing Program Analysts (LPAs) Janai McClain and Indira Loza met with Licensee Trina Hill-Wallace for an Unannounced Annual Inspection. Present during the inspection were her daughter Jahnell, minor granddaughter, two infants, four preschoolers, and two school aged children in care. The home was toured for a health and safety inspection. The facility operates from 8:00am – 5:00pm Monday through Friday.

The home is a two story house that consists of three bedrooms and three bathrooms. The entrance to the day care is on the left side of the house through the gate to the back area of the house. The inside of the home was observed to be neat and clean with ample age appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be inaccessible to children.

ON LIMITS AREA: The classroom which is the main area of the day care, the office, the bathroom in the classroom, and the fenced in backyard.
OFF LIMITS AREA: The front of the house which consists of the living room, family room, dining room, kitchen, all bedrooms, and the entire downstairs. Off limit areas will be made inaccessible by closed and/or locked doors.
ISOLATION AREA: The left side of the classroom.

The home has a fully charged 2A10BC fire extinguisher, a working smoke detector and a functioning carbon monoxide detector located in the main area. A push button fire alarm is located on the back side wall near the sliding door. The Licensee has provided a working telephone number and email address. Licensee Trina's CPR and First Aid certificate is current and expires on 08/2025. Licensee Shirley's CPR and First Aid certificate expired on 02/13/2021. The fireplace is blocked off with a gate preventing access by children. Per Licensee, there are no firearms in the home. LPAs reviewed staff and children's files which were all complete and current. All required forms are posted and visible for public view.
**********************************Report Continues on LIC 809-C*******************************
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2024
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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HILL-WALLACE, TRINA & HILL, SHIRLEY
FACILITY NUMBER: 013423548
VISIT DATE: 01/26/2024
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The fire drill log was available and the last fire drill was conducted on 11/13/2023. The licensee was reminded of the required mandated reporter training and has provided proof of the required training which expires on 7/13/2025.

Incidental Medical Services (IMS) policy was discussed. The Licensee is not currently providing IMS to the children in care. For IMS information see PIN 22-02. When any IMS is a Plan for Providing 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/childqanda.htm

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 on 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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/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 their purchased equipment. LPA provided the Licensee with the Infant Safe Sleep Regulations.

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. **********************************Report Continues on LIC809-C*******
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024
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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HILL-WALLACE, TRINA & HILL, SHIRLEY
FACILITY NUMBER: 013423548
VISIT DATE: 01/26/2024
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During the Exit Interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.

There was 2 Type B deficiencies cited during today's visit. See LIC809-D.

Exit interview conducted and report was reviewed with Licensee Trina Hill-Wallace.
Report and Appeal Rights were provided.
A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/26/2024 04:55 PM - It Cannot Be Edited


Created By: Janai McClain On 01/26/2024 at 04:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: HILL-WALLACE, TRINA & HILL, SHIRLEY
FACILITY NUMBER: 013423548

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as her mandated reporter certificate expired on 06/05/2023, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/26/2024
Plan of Correction
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Licensee shall complete the mandated reporter training and email LPA a copy of the certificate no later than 02/26/2024.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as her CPR and First Aid certificate expired on 2/13/2021, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/26/2024
Plan of Correction
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Licensee shall complete the CPR and First Aid training and email LPA a copy of the certificate no later than 02/26/2024.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mayla Mendoza
LICENSING EVALUATOR NAME:Janai McClain
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2024


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