015700253-10-18-2021-52-CC-EWOS-C7WN9E-20211018101550

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700253
Report Date: 10/18/2021
Date Signed: 10/18/2021 10:16:02 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:	HAYNES, DEANNA		FACILITY NUMBER:	015700253
ADMINISTRATOR:	HAYNES, DEANNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 755-5910
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY:	14	CENSUS: 1	DATE:	10/18/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Deanna Haynes		TIME COMPLETED:	10:30 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	Licensing Program Analyst (LPA) Elimika Woods met with applicant Deanna Haynes for an Announced Pre-Licensing Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the applicant. Present during the inspection was one (1) infant child. Applicant stated that the facility plans to operate her facility from Monday to Friday 7:00 AM to 6:00 PM. LPA toured the facility to conduct a Health and Safety inspection. This two story home was clean and orderly, with heating and ventilation for the safety and comfort of children in care. The Isolation area will be a section of the day care room. On- Limit areas are the: Day care room and bathroom downstairs, deck and backyard Off- Limit areas are the: Entire second level of home, laundry room, kitchen, living and dining room, and garage The off-limits are will be made inaccessible by closed and/or locked doors and visual supervision. There's a gate at the bottom of the stairs preventing children five (5) years of age and younger access. There's a fireplace in the living room that is screened and is off limits to children in care. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today's inspection. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. There are ample age appropriate toys that appear to be safe and in good condition The home has a fully charged 2A10BC fire extinguisher, wired smoke and carbon monoxide detector, first aid kit, and telephone. Per licensee, there are no firearms in the home. The applicant is in compliance with the immunization laws which pertains to all childcare providers. See 809-C for continuance

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: HAYNES, DEANNA	FACILITY NUMBER: 015700253
	VISIT DATE: 10/18/2021

NARRATIVE

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The OUTDOOR PLAY area is the fully fenced backyard and LPA observed that it is free from defects or dangerous conditions. During today's inspection, there are no play structures which are required to be anchored.

A copy of the mortgage statement was reviewed and shows control of property. The applicant completed and received a certificate in mandated reporter training on 03/05/20. Applicant's CPR and First Aid certificate is current and expires 10/24/2022.

California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

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

LPA informed the applicant that all forms can be downloaded at www.ccld.ca.gov and encouraged the applicant to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The applicant was also reminded that Mandated Reporter Training is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

See 809-C

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021

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: HAYNES, DEANNA	FACILITY NUMBER: 015700253
	VISIT DATE: 10/18/2021

NARRATIVE

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CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

The applicant is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. The applicant was provided information regarding effects of Lead Exposure and testing requirements (Assembly Bill 2370).

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

Applicant 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.

This home is recommended for Licensure on 10/18/2021. This report shall remain on file for 3 years. Exit interview conducted applicant, Deanna Haynes

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021

LIC809 (FAS) - (06/04)

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