013423679-4-4-2022-02-CC-MDOY-CD6U58-20220404151620

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423679
Report Date: 04/04/2022
Date Signed: 04/04/2022 03:16:30 PM

Document Has Been Signed on 04/04/2022 03:16 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	SANTANA, GERALDO		FACILITY NUMBER:	013423679
ADMINISTRATOR:	SANTANA, GERALDO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 527-1652
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94702
CAPACITY:	14	CENSUS: 0	DATE:	04/04/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	GERALDO SANTANA		TIME COMPLETED:	03:35 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 4/4/22, at 1:40PM, Licensing Program Analysts (LPAs) Melissa Domantay and Indira Loza arrived announced for a pre-licensing inspection and met with Applicant/Licensee Geraldo Santana. Present for the inspection was the Licensee's 2.5 year old daughter. Living in the home is Applicant, applicants wife, son who is 5 years old, and 2.5 year old daughter and son. There are no children in care during todays inspection. The purpose of the inspection is a pre-licensing for a large family child care home and to conduct a health and safety check. A fire clearance was received from the Berkeley Fire Department. Operating hours will be 8:30AM to 5:00PM, Monday through Friday. The home is single family home with 2 bedrooms and one bathroom. The ON limit areas will be the living room, dining room, the kitchen, 2 bedrooms through the hallway door, and the bathroom, and the fenced in backyard. The ISOLATION AREA will be the bedroom to the left when you enter hallway. Outdoor play area will be in the backyard which is fenced in all around. There is turf and tan bark surrounding the back yard play area, and a sandbox, which applicant is reminded to keep clean. Back yard has a play structure and Applicant is reminded that 100% supervision is required to ensure children's safety. The staircase that leads to the back yard is gated. Applicant is asked to add a lock to the backyard door that leads into the street to ensure it is unable to be unlocked by children. Applicant will provide photo of backyard door with lock to LPA Domantay. There is a wall heater in the dining room that is shielded. There are no pools, hot tubs or any other bodies of water during today's inspection. The home has a fully charged 2A10BC fire extinguisher, a working combination smoke and carbon monoxide detector in the living room and a first aid kit. Applicant has a working telephone. The Licensee's CPR and First Aid certificate, mandated reporter training, and preventative health with lead poisoning training are all current. Per Applicant, there are no firearms in the home. Report continues on 809C.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Melissa Domantay	TELEPHONE: 510-725-7021
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: SANTANA, GERALDO	FACILITY NUMBER: 013423679
	VISIT DATE: 04/04/2022

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
26
27
28
29
30
31
32

The Applicant was reminded of the responsibility as a mandated reporter.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPAs 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.

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

The Applicants home is licensed for a large family day care as of today 4/4/2022. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the applicant.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Melissa Domantay	TELEPHONE: 510-725-7021
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2