013423570-3-18-2020-02-CC-DCAS-BMTR54-20200318124231

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423570
Report Date: 03/18/2020
Date Signed: 03/18/2020 12:42:46 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:	RUSSELL, LENETTE		FACILITY NUMBER:	013423570
ADMINISTRATOR:	RUSSELL, LENETTE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 459-4955
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94621
CAPACITY:	14	CENSUS: 0	DATE:	03/18/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Lenette Russell		TIME COMPLETED:	01:00 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 03/18/2020 at 11:00am Licensing Program Analyst (LPA) Diana Campos arrived for an announced Pre-licensing Inspection. Applicant was previously licensed at a different location. Present for this inspection was applicant Lenette Russell. No other adults present during this inspection The home was toured with the applicant to conduct a health and safety inspection. Applicant states the hours of operation for day care will be Sunday through Saturday 6:00am-5:00am (23 hours). The home is two story, which consists of a backyard, garage, (upper level) kitchen, living room, dining room, 3 bedrooms, bathroom, and small laundry room. (Lower level) class room/play room, coat closet/cubby area, kitchen, and bathroom. The home is neat and clean with heating and ventilation for safety and comfort. ON LIMITS: Entire lower level which includes a classroom/play room, children's coat closet/cubby area, kitchen, and bathroom The isolation area will be the play room. OFF LIMITS: Entire second floor, garage, and back yard. All off limit areas will be inaccessible by closed and/or locked doors and visual supervision at all times. The applicant was advised to contact Licensing, so that an inspection can be completed prior to changing an off limits area to on limits. There are ample age appropriate toys and activity materials which are observed to be safe, clean and in good repair. There are no pools, hot tubs or any other bodies of water. LPA did not observe any hazardous materials or toxins accessible to children today. The home has a fully charged 3A40BC fire extinguisher, working combination carbon monoxide/smoke detectors, telephone, and fully stocked first aid kit. Per applicant there are no firearms in the home.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana Campos	TELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2020

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: RUSSELL, LENETTE	FACILITY NUMBER: 013423570
	VISIT DATE: 03/18/2020

NARRATIVE

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The applicant’s health and safety training has been completed, and First Aid/CPR certificate is current, expiring on 09/22/2020 . A copy of the mortgage statement has been reviewed and shows control of property. The applicant has provided proof of the required immunizations, and the required mandated reporter training was completed on 12/10/2018. Safe Sleep practices, and Effects of Lead Exposure and testing requirements information brochures were discussed and provided. Applicant was reminded that children are never to be left in a parked vehicle.

Individual Medical Services (IMS) policy was discussed. Per licensee, no IMS is being provided at this time. The licensee was reminded that when any changes to the IMS plan is made, an updated 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.”

The applicant 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.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana Campos	TELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2020

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: RUSSELL, LENETTE	FACILITY NUMBER: 013423570
	VISIT DATE: 03/18/2020

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Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The licensee/director was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com. LPA may visit facility to confirm any pending corrections have been complete.

This home is recommended for licensure today.

This report shall remain on file for 3 years.

Exit interview conducted with Lenette Russell, and copy of report provided.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana Campos	TELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2020

LIC809 (FAS) - (06/04)

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