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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700165
Report Date: 12/03/2021
Date Signed: 12/03/2021 11:35:25 AM

Document Has Been Signed on 12/03/2021 11:35 AM - 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, NIKKIFACILITY NUMBER:
015700165
ADMINISTRATOR:MURRAY, NIKKIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(724) 420-7863
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 7DATE:
12/03/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Nikki MurrayTIME COMPLETED:
11:40 AM
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On December 3, 2021 at approximately 10:31am Licensing Program Analyst (LPA) Russ Haderer met with licensee Nikki Murray for the purpose of conducting an unannounced inspection to review and approve a new play structure in the on-limits area of the back yard. Present for today’s inspection was licensee’s fingerprint and TB cleared partner Kyle Keane, two infants, two 2-years old, two 3-years old; one 4-years old.

The new play structure is solid, has a second floor, a plastic slide on the left side, and a 7 foot climbing wall on the right side. The new play structure is in safe condition and is free from sharp, loose or pointed parts. The areas around or under has appropriate cushioned material that absorbs a fall. Licensee advised that an adult must always be present when children use the climbing wall to assure they do not fall. There are other ample age-appropriate toys that appear to be safe and in good condition. There are no bodies of water accessible to children in care.

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.

LPA discussed the safe sleep regulations with licensee Nikki Murray 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 [facility representative] 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.

The new play structure is approved as of this day, December 3, 2021. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Nikki Murray.

Chandra Charles
Russell Haderer
DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2021
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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