015700165-3-25-2021-52-CC-RHAR-BZFU99-20210325152246

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700165
Report Date: 03/25/2021
Date Signed: 03/25/2021 03:22:59 PM

Document Has Been Signed on 03/25/2021 03:22 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	MURRAY, NIKKI		FACILITY NUMBER:	015700165
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 5	DATE:	03/25/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	01:08 PM
MET WITH:	Nikki Murray		TIME COMPLETED:	03:40 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 March 25, 2021 at approximately 1:08pm Licensing Program Analyst (LPA) Haderer arrived for an announced case management visit for a capacity change inspection. Present in the home today was licensee Nikki Murray, her fingerprint cleared partner Kyle Keane, and five children in care: one 9-month old infant, one 2-year old and three 3-year olds.

All requested documents were received for the increase of capacity application. The fire clearance for a capacity of 14 was received from the Fremont Fire Department on 03/25/2021. The Licensee was reminded to abide by the conditions of the fire clearance. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home. The home was toured and inspected for health and safety. LPA inspected all on-limits areas, including the front and backyard.

The home is rented by the licensee and contains a living room, dining room, kitchen, den, two bedrooms and two bathrooms, two-car garage and enclosed (fenced) outside front and back yard areas. Rental agreement and signed landlord consent agreement has been submitted to licensing.

The home is neat and clean with heating and ventilation for safety and comfort. It has wall heaters; the hallway heater is in the gated off-limits area; the heater in the living room has a movable child gate that will be placed in front of the unit whenever it is operating and children are present. Per the licensee, the ISOLATION AREA will be in the den area and away from the other children in care.

On-limit areas include: Living room (main day care area), den (dramatic play room), dining room, house bathroom (next to the kitchen), front yard, north side yard, and back yard. The home has age-appropriate learning materials. Licensee was reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) cleaning products. There are no accessible hazardous cleaning chemicals or other liquids in the on-limits area.

Chandra Charles
Russell Haderer
	DATE: 03/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021

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 4

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: MURRAY, NIKKI	FACILITY NUMBER: 015700165
	VISIT DATE: 03/25/2021

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

Off-limit areas include: The Kitchen, master bedroom with attached bathroom, second bedroom, two car garage and fenced/locked south side of house (outside yard area). The off-limit areas will be inaccessible by closed and/or locked doors, and/or by child supervision.

The gardening area in the front yard was neat and tidy and had no tools or other dangerous items present, the play area in the main backyard has soft ground cover materials, safe and solid play structures and ample age-appropriate toys in good condition.

LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection.

Licensee has a first aid kit and plastic outlet covers on all electrical outlets in on-limit areas.

Licensee The home has a fully charged 2A10BC fire extinguisher, four working smoke and a carbon monoxide detector (tested and functioning). The licensee's Health and Safety training is completed, and CPR and First Aid certificate is current and expires 12/07/2021. The applicant completed and received a certificate in mandated reporter training (verified AB1207), expires on 08/09/2022. Licensee is in compliance with the immunization laws which pertains to day care providers.

LPA reminded Licensee of the following; Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. There is a fireplace in the home (not in use) with a gate in the opening and per licensee, there are no firearms in the home. Ratios were discussed and a copy left for licensee.

Sample children's files were examined for compliance to Title 22 regulations. One child's file (C4) was missing LIC 627B Consent for Medial Treatment. A Type B violation was issued today. The child's parent was contacted and came to the home to complete and sign a consent form. Violation was immediately corrected today.

102417(g)(7) regulation:
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

SUPERVISOR'S NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021

LIC809 (FAS) - (06/04)

Page: 2 of 4

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: MURRAY, NIKKI	FACILITY NUMBER: 015700165
	VISIT DATE: 03/25/2021

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

Licensee is 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. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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 is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

LPA reviewed guidance on operating safely during the Covid pandemic. Posters were present and the checking in process of children was observed.

LPA provided a copy of Safe Sleep-in Child-Care brochure, a handout "What Does A Safe Sleep Environment Look Like?" and a copy of the new California Car Seat Law Changes.

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

This home is recommended for an increase of capacity. There was one deficiencies cited today and corrected by the parent arriving to sign a medical consent form.

This facility report will remain on file for three years. A notice of site visit was provided, and the licensee was reminded to have it posted for 30 days. An exit interview was conducted, and appeal rights provided.

SUPERVISOR'S NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 03/25/2021 03:22 PM - It Cannot Be Edited

Created By: Russell Haderer On 03/25/2021 at 02:36 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: MURRAY, NIKKI	FACILITY NUMBER: 015700165
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/25/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/25/2021 Section Cited	1 2 3 4 5 6 7	102417 Operation of a Family Child Care Home (g)(7) .... the parent's authorization for the licensee or registrant to consent to emergency medical care.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on observation and interview, the licensee did not maintain a signed LIC 627B Consent for Medial Treatment in a child's file, which poses a health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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:

Chandra Charles

TELEPHONE:

LICENSING EVALUATOR NAME:

Russell Haderer

TELEPHONE:

LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021

LIC809 (FAS) - (06/04)

Page: 4 of 4