015700223-3-19-2021-52-CC-LDBX-BZ9NPX-20210319103903

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700223
Report Date: 03/19/2021
Date Signed: 03/19/2021 10:39:24 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	DALE, LINDSEY		FACILITY NUMBER:	015700223
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	03/19/2021
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Lindsey Dale		TIME COMPLETED:	10:50 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	March 19, 2021, at 08:35 AM Licensing Program Analyst (LPA) L. Dacanay Breaux and LPA R. Haderer met with Licensee Lindsey Dale for the purpose of an Announced Relocation Pre licensing Inspection for Health and Safety Compliance. Present for the inspection was fingerprint cleared husband Sean Widger. Licensee states hours of operation will be Monday – Friday 8:00AM – 6:00 PM. This residence is a 3 bedroom and 2 baths single story home rented by the Licensee. Home consist of living room, dining room, kitchen, back and side yards and attached two car garage. The home is neat and clean with heat and ventilation for safety and comfort. Per the licensee, the ISOLATION AREA will be in the living room away from children in care. These areas are designated as follows: Areas off-limits: Kitchen, All three bedrooms, Laundry Room and Garage. Small (gated) side yard on the right/north side of house, rear sloped grassy/landscaped section near the back of property line fence in back yard, and gazebo (gated and not accessible to children in care). Shed near the gravel area which is locked and secured. The off-limit areas will be inaccessible by a barrier gate, closed and/or locked doors. Areas on-limits: Living room, Dining room, main house bathroom (available for children use) and back yard that consists of main area on the west and south side of the home. Continued on page 2.........................................

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: DALE, LINDSEY	FACILITY NUMBER: 015700223
	VISIT DATE: 03/19/2021

NARRATIVE

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LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection. There are age appropriate toys, learning materials, and equipment that appear to be safe and in good condition. There is a screened and locked fireplace in the living room, hearth has padding attached for safety.

LPA went over self-assessment during inspection. LPA discussed with licensee the importance of preventing the spread of COVID-19 and provided technical assistance including postings.

There is a fully charged fire extinguisher 3A40:BC, carbon monoxide and smoke detector are in operable condition. First Aide Kit, Door Knob Covers and Outlet Covers were in place in the child care areas for a safety. Licensee states there is two pet dogs in the home and three chickens in a coop in the backyard. Licensee states there are no weapons, firearms or ammunition on premises.

Licensee Preventative Health and Safety training was completed on 08/17/2019. Pediatric CPR and First Aid certification expires on 12/9/2022. Mandated Reporter Training certification expires on 08/25/2021. Family childcare home orientation was completed on June 2019. Child Care Lead Poisoning Prevention Training was complete on 01/26/2021. Licensee is following new immunization law which pertains to day care providers. Licensee reminded that CPR/1st Aide and Mandated Reporter must be renewed every two years.

A copy of the rental agreement was reviewed, and a property owner consent form was signed. Ratios were discussed and a copy left for licensee as a reminder.

Children's records were reviewed for completeness and found to be in compliance with Title 22 requirements. Facility files were reviewed for completeness and found to be in compliance with Title 22 requirements.

Continued on page 3.................................

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: DALE, LINDSEY	FACILITY NUMBER: 015700223
	VISIT DATE: 03/19/2021

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. 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.

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

Baby bouncers & drop-down cribs are not allowed at the day-care facility. LPA discussed Unusual Incidents Reports.

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

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. The licensee was also provided information regarding effects of Lead Exposure and testing requirements (Assembly Bill 2370).

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

LPAs and licensee reviewed this report. Signed copies will be provided. This home is recommended for licensing on 03/19/2021. This report shall remain on file for 3 years. Exit interview conducted licensee.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021

LIC809 (FAS) - (06/04)

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