013423587-5-6-2021-02-CC-PDYR-C2RPG2-20210506111737

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423587
Report Date: 05/06/2021
Date Signed: 05/06/2021 11:17:43 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:	ANDRADA, MIYANI		FACILITY NUMBER:	013423587
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 8	DATE:	05/06/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Miyani Andrada		TIME COMPLETED:	11:30 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 Analyst (LPA) L. Dyer met with licensee Miyani Andrada for an unannounced Increase in Capacity inspection. Present was the licensee, her assistant, 4 preschoolers and 4 school age children. LPA toured the facility for a health and safety inspection. The home was equipped with a first aid kit, a fully charged 3-A:40-B:C fire extinguisher, a working smoke detector (tested), and a carbon monoxide detector. Fire safety inspection by the Oakland Fire Department was approved on 3/12/21 with Code 1 - Fire Clearance Granted. Per the fire marshal's instructions, licensee has installed an exit sign and insured that windows and exits are not blocked. Licensee had files for all children in care; a sample was reviewed. No stairs inside of the home. The heater is blocked. There was a working telephone. The licensee stated there were no firearms or bodies of water on the premises. Fireplace was blocked. There were a variety of books and toys for children's use. No pets. Back yard consists of a concrete and faux grass area. Forms were reviewed. The last disaster drill was November 24, 2020. Licensee stated there is one adult that lives in the home. All staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee's fees are current. Pediatric First aid and CPR cards expire on 4/24/22. Licensee's Mandated Reporter Training expires 5/23/22. Licensee's immunization records have been reviewed. The ratio poster was given to the licensee. The handout, "A Child Care Provider's Guide to Safe Sleep" was provided and discussed. Individual Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, 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.htp. (continued)

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) -28-4353
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021

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: ANDRADA, MIYANI	FACILITY NUMBER: 013423587
	VISIT DATE: 05/06/2021

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Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children, or an immediate civil penalty can be assessed; and to notify the department IN WRITING if she decides to move or discontinue the license. Mandated reporting and Zero Tolerance Regulations were also discussed.

A QUALIFIED ASSISTANT MUST BE PHYSICALLY PRESENT AND INVOLVED IN CARING FOR CHILDREN WHENEVER 9 OR MORE CHILDREN ARE PRESENT AT A LARGE FAMILY CHILD CARE HOME. WHEN AN ASSISTANT IS NOT PRESENT, THE HOME REVERTS BACK TO SMALL FAMILY CHILD CARE RATIOS.

Licensing regulations, updates and forms can be obtained from our website: www.ccld.ca.gov.

License for Increase In Capacity is recommended pending receipt of all final clearances and the completion of all requirements.

A license will be processed as soon as administratively possible.

For CCL Updates, go to www.ccld.ca.gov. Click the "Receive Important Updates" box. Enter your e-mail address.

Exit interview conducted. Appeal rights were discussed and given. Notice of site visit must be posted for 30 days. This report must be available for public review for 3 years.

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) -28-4353
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021

LIC809 (FAS) - (06/04)

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