013423642-5-18-2021-02-CC-DCAS-C35NFE-20210518102525

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423642
Report Date: 05/18/2021
Date Signed: 05/18/2021 10:25:56 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:	LANUZA, ANA		FACILITY NUMBER:	013423642
ADMINISTRATOR:	LANUZA, ANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 335-2572
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94601
CAPACITY:	14	CENSUS: 2	DATE:	05/18/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Ana Lanuza		TIME COMPLETED:	10:40 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	On 5/18/2021 at 8:45am, Licensing Program Analyst (LPA) Diana Campos arrived at the home for an announced pre licensing, change of location, inspection. LPA met with Ana Lanuza. There was 1 infant child in care and licensee's own minor nephew who lives in the home. Also present during the inspection was licensee's cousin who lives in the home and her own 2 fingerprint cleared adult sons. LPA toured the home with the licensee. The home is a single story home, which consists of the living room, dining area, kitchen, 4 bedrooms, 2 bathrooms, basement, and detached garage. The home is neat and clean with heating and ventilation for safety and comfort. The on limit areas include the living room, dining area, kitchen, first bedroom to the right of front door. Bathroom to the right of kitchen, and the front yard. The off limit areas include the second bedroom to the right of living room, the bedroom to the left of bathroom in the hallway, the bedroom to the right of the back door, the bathroom to the left of the back door, the basement, backyard, and the detached garage. These areas are made inaccessible by closed and/or locked doors and visual supervision. The isolation area will be the bedroom to the right of front door away from other children in care. The outdoor play area is the fenced front yard, and it is free from defects or dangerous conditions. There is an ample supply of age appropriate toys and activities accessible to children, and LPA observed that they are in good condition. There are 2 fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, telephone and fully stocked first aid kits. The heater vents are on ceiling. LPA did not observe any bodies of water, hazardous items or toxins accessible to children today. Per the licensee, there are no firearms in the home. Licensee has current CPR and first aid certificates which expire on 01/25/2022. Licensee has proof of completion of the required mandated reporter training, dated 01/06/2020. LPA reviewed the mortgage statement, and it shows control of property. continued on 809-C

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana Campos	TELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2021

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: LANUZA, ANA	FACILITY NUMBER: 013423642
	VISIT DATE: 05/18/2021

NARRATIVE

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Incidental 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.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.

The applicant was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to sign up to receive quarterly updates by email by sending a request to ChildCareAdvocatesProgram@dss.ca.gov. The applicant was given a copy of A Child Care Provider's Guide to Safe Sleep pamphlet and LPA discussed safe sleep practices and policy.

This home is recommended for licensing. LPA reminded the applicant that compliance with all Title 22 regulations and applicable Health and Safety regulations, must be maintained at all times. This report shall remain on file for 3 years. Exit interview conducted.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana Campos	TELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2021

LIC809 (FAS) - (06/04)

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